Role of primary surgery alongwith metastatectomy and adjuvant therapy in patients with follicular thyroid cancer with skeletal metastases as an initial presentation.

  • Background: Patients from endemic areas do present with distant metastasis in Follicular Thyroid Carcinoma(FTC).

    AIM: To assess surgical and adjuvant treatment outcomes in patients with FTC with skeletal metastases.

    METHODS: Retrospective analysis of prospectively maintained data base of all patients with FTC with skeletal metastases managed during June, 2016 to June,2018 was done.

    RESULTS: We had total of 45 patients who presented with FTC and out of these, 18 (40%) patients presented with skeletal metastases as initial presentation along with goiter. Mean age was 45 years (range 19 to 72 years) and female: male (11:7). Mean duration of goiter was 18 + 4.5 months and skeletal metastases was 9 + 2 months. All patients were residing in iodine deficient areas of northern India. Surgical options included total thyroidectomy(TT, n=18), additional procedures along with TT included nodal dissection ( central compartment n=2, central and lateral compartment n=3), hemi-claviculectomy(n=5), rib resection (n=4), sternal partial excision with mesh reconstruction (n=2), skull metastasis excision(n=1)  and superior venacava thrombectomy (n=2). Solitary: multiple site skeletal metastases (n=5: n=13). All patients received adjuvant RAIA, ZA and RT (n=4). No major peri-operative morbidity. One patient died 2 years after treatment. Recurrence seen in two patients, one underwent excision and one was managed with palliative systemic therapy in view of distant visceral metastases.

    CONCLUSION: Surgical excision of skeletal metastases along with TT is a feasible option for patients with FTC who present with skeletal metastases as an initial presentation followed by mutli-modality treatment.

 

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