Stage IV Papillary and Follicular Thyroid Cancer
The most common sites of metastases are lymph nodes, lung, and bone. Treatment of lymph node metastases alone is often curative. Treatment of distant metastases is usually not curative but may produce significant palliation.
Standard treatment options:
- I131: Metastases that demonstrate uptake of this isotope may be ablated by therapeutic doses of I131.
- External-beam radiation therapy for patients with localized lesions that are unresponsive to I131.
- Resection of limited metastases, especially symptomatic metastases, should be considered when the tumor has no uptake of I131.
- Thyroid-stimulating hormone suppression with thyroxine is also effective in many lesions not sensitive to I131.
Patients unresponsive to I131 should also be considered candidates for clinical trials testing new approaches to this disease.
Treatment options under clinical evaluation:
- Clinical trials evaluating new treatment approaches to this disease should also be considered for these patients. Chemotherapy has been reported to produce occasional complete responses of long duration.[2-4] Oral inhibitors of vascular endothelial growth-factor receptors are under clinical evaluation.[Level of evidence: 2Dii]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV papillary thyroid cancer and stage IV follicular thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
- Simpson WJ, Carruthers JS: The role of external radiation in the management of papillary and follicular thyroid cancer. Am J Surg 136 (4): 457-60, 1978. [PUBMED Abstract]
- Gottlieb JA, Hill CS Jr, Ibanez ML, et al.: Chemotherapy of thyroid cancer. An evaluation of experience with 37 patients. Cancer 30 (3): 848-53, 1972. [PUBMED Abstract]
- Harada T, Nishikawa Y, Suzuki T, et al.: Bleomycin treatment for cancer of the thyroid. Am J Surg 122 (1): 53-7, 1971. [PUBMED Abstract]
- Shimaoka K, Schoenfeld DA, DeWys WD, et al.: A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 56 (9): 2155-60, 1985. [PUBMED Abstract]
- Sherman SI, Wirth LJ, Droz JP, et al.: Motesanib diphosphate in progressive differentiated thyroid cancer. N Engl J Med 359 (1): 31-42, 2008. [PUBMED Abstract]