Differentiated thyroid carcinoma can grow
rapidly in older patients
(July 2003)
The background of
the study. Most patients with differentiated thyroid carcinoma
are relatively young, but older patients may be affected. This study
was done to define the clinical characteristics and course of this
tumor in older patients.
How the study was done. The study
group was 111 patients with differentiated thyroid carcinoma who
were ≥70 years old and who were followed for two or more years
after initial therapy. They constituted 8 percent of all patients
with differentiated thyroid carcinoma seen at one center since 1949.
The patients' records were reviewed for information about presentation,
pathologic findings, therapy, and outcome.
The results of the study. There
were 83 women and 28 men; the median age was 75 years. The initial
sign of the tumor was a thyroid nodule in 89 patients (80 percent),
enlarged cervical lymph nodes in 17 patients (15 percent), and bone
pain in 6 patients (5 percent). Fifty-eight patients (52 percent)
had a papillary carcinoma, 46 (41 percent) a follicular carcinoma,
and 7 (6 percent) a Hurthle-cell carcinoma. Treatment consisted
of total thyroidectomy in 46 patients (41 percent), partial thyroidectomy
in 36 patients (33 percent), and biopsy in 29 patients (26 percent).
Subsequently, 20 percent received a single dose of radioactive iodine
(I-131), and 52 percent received multiple doses. Twenty-two percent
were treated with radiation for local recurrence or palliation of
pain from bone metastases.
During a median follow-up period of 9 years, 21 percent of the
patients had a local recurrence and 15 percent had distant metastases.
The overall survival rates were approximately 50 percent at 5 years
and 25 percent at 10 years, and the tumor-related survival rates
were 75 percent, 50 percent, and 50 percent at 5, 10, and 15 years,
respectively. Older age (≥80 years), lymph node metastases,
and external-beam radiotherapy were associated with a low tumor-related
survival rate, and follicular-cell histology and total thyroidectomy
with a high tumor-related survival rate.
The conclusions of the study. Among
older patients, differentiated thyroid carcinomas can be aggressive.
The original article. Vini L, Hyer
SL, Marshall J, A'Hern R, Harmer C. Long-term results in elderly
patients with differentiated thyroid carcinoma. Cancer 2003;97:2736-42.
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