PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.
Diagnosis ; Gangwon-do ; Humans ; Radiotherapy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Carcinoma ; radiotherapy ; Carcinoma, Papillary ; radiotherapy ; Humans ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Thyroid Neoplasms ; radiotherapy

PURPOSE: Anaplastic thyroid carcinoma is characterized by a rapid growing mass of the neck and an early infiltration into the surrounding tissue. Because of its mature expression in elderly patients who have a poor general physical condition, a difficulty in diagnosis and the lack of effective treatment, it is one of the most lethal cancers that occur in human. The aim of this study was to investigate the clinicopathologic character of anaplastic thyroid carcinoma and analyze the prognostic factors affecting the survival rate. METHODS: The history of twenty patients who were diagnosed as having anaplastic thyroid carcinoma at Seoul National University Hospital between 1985 and 1999 were reviewed retrospectively. RESULTS: The most common symptom was a rapidly enlarging neck mass. Ten (55.5%) of 18 patients had concomitant well differentiated thyroid carcinomas and 5 (27.8%) patients had benign thyroid disease on the basis of the presenting pathologic features. The median survival time was 5.5 months and the 2-year survival rate was 27.3%. Among several factors that were analyzed, a tumor size smaller than 5 cm (p<0.001), the absence of distant metastases at presentation (p=0.020), patients that were selected for curative surgical resection (p=0.002), and postoperative radiotherapy (p=0.003) were associated with prolonged survival time. CONCLUSION: In the selected patients (tumor size<5 cm, the absence of distant metastases at presentation, young age (<55)), curative surgical resection and adjuvant radiotherapy may result in an increased survival time.
Aged ; Diagnosis ; Humans ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Seoul ; Survival Rate ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND AND OBJECTIVES: Anaplastic carcinoma of thyroid gland is a lethal entity: few patients live more than 12 months following the diagnosis. We retrospectively reviewed the experience with this entity at our institute with respect to prognostic factors influencing survival. MATERIALS AND METHODS: Thirteen cases of anaplastic carcinoma of thyroid gland diagonsed from 1995 to 2000 were analyzed retrospectively. The median age at presentation was 66.2 years; the male/female ratio was 1.17:1: and the most common symptom was a rapidly enlarging neck mass. RESULTS: All but one patient died within one year of diagnosis. Tumor size of less than 7 cm and complete resection of tumor were significant prognostic factors. Patients who had operation with or without radiotherapy and/or chemotherapy survived significantly longer than other patients. Median survival duration was 74 days. CONCLUSION: This study showed that complete resection and multimodal treatment for tumor of size less than 7 cm resulted in prolonged survival for a subgroup of patients with anaplastic thyroid carcinoma.
Carcinoma* ; Combined Modality Therapy ; Diagnosis ; Drug Therapy ; Humans ; Neck ; Radiotherapy ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms

PURPOSE: Anaplastic thyroid carcinoma is characterized with rapid growing mass of the neck and early infiltration into the surrounding tissue. Because of its advanced presentation in elderly patients with poor general condition, difficulty in diagnosis and lack of effective treatment, it is one of the most lethal cancers in human. The aim of this study was to investigate the clinicopathologic character of anaplastic thyroid carcinoma and analyze the prognostic factors affecting survivals. METHODS: Twenty patients diagnosed anaplastic thyroid carcinoma in Seoul National University Hospital between 1985 and 1999 were reviewed retrospectively. RESULTS: The most common symptom was a rapidly enlarging neck mass. Ten (55.5%) of 18 patients had a concomitant well differenciated thyroid carcinomas and 5 (27.8%) patients had benign thyroid disease on pathologic features. The median survival was 5.5 months and the 2-year survival rate was 27.3%. Among several factors analyzed, tumor size smaller than 5 cm (p<0.001), absence of distant metastases at presentation (p=0.020), patients selected for curative surgical resection (p=0.002), and postoperative radiotherapy (p=0.003) were associated with prolonged survival time. CONCLUSION: In the selected patients(tumor size <5 cm, the absence of distant metastases at presentation, young age (<55), curative surgical resection and adjuvant radiotherapy may be associated with an increased survival time.
Aged ; Diagnosis ; Humans ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Seoul ; Survival Rate ; Thyroid Carcinoma, Anaplastic* ; Thyroid Diseases ; Thyroid Neoplasms

Sorafenib is an emerging therapeutic option for radioactive iodine (RAI)-refractory differentiated thyroid carcinoma. However, the effects of sorafenib as an adjuvant treatment following surgery or radiation on brain metastases from poorly differentiated thyroid carcinoma (PDTC) have never been reported. A 52-year-old patient underwent total thyroidectomy for follicular thyroid carcinoma. Despite high-dose RAI therapy, a neck mass and lung metastases were developed. PDTC was diagnosed by neck mass removal. During adjuvant external beam radiation therapy (EBRT) to the neck, brain metastases developed. After palliative EBRT for brain metastases, the brain tumor size decreased but lung metastases markedly progressed. Off-label sorafenib was used to treat progressive multiple metastatic lesions. Over five months of sorafenib treatment, the sum of the longest diameters for target lesions was decreased by 45% in brain and 13% in lung. Sorafenib can be considered a new adjuvant therapeutic option for metastatic brain lesions from PDTC after EBRT.
Adenocarcinoma, Follicular ; Brain Neoplasms ; Brain* ; Humans ; Iodine ; Lung ; Middle Aged ; Neck ; Neoplasm Metastasis* ; Radiotherapy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: The purpose of this study is to assess the clinicopathologic features, treatment outcomes, and role of adjuvant radiation therapy (RT) in cervical thymic neoplasm involving the thyroid gland or neck. MATERIALS AND METHODS: The medical and pathologic records of eight patients with cervical thymic neoplasm were reviewed retrospectively. All patients underwent surgical resection, including thyroidectomy or mass excision. Adjuvant RT was added in five patients with adverse clinicopathologic features. The radiation doses ranged from 54 Gy/27 fractions to 66 Gy/30 fractions delivered to the primary tumor bed and pathologically involved regional lymphatics using a 3-dimensional conformal technique. RESULTS: Eight cases of cervical thymic neoplasm included three patients with carcinoma showing thymus-like differentiation (CASTLE) and five with ectopic cervical thymoma. The histologic subtypes of ectopic cervical thymoma patients were World Health Organization (WHO) type B3 thymoma in one, WHO type B1 thymoma in two, WHO type AB thymoma in one, and metaplastic thymoma in one, respectively. The median age was 57 years (range, 40 to 76 years). Five patients received adjuvant RT: three with CASTLE; one with WHO type B3; and one with WHO type AB with local invasiveness. After a median follow-up period of 49 months (range, 11 to 203 months), no recurrence had been observed, regardless of adjuvant RT. CONCLUSION: Adjuvant RT after surgical resection might be worthwhile in patients with CASTLE and ectopic cervical thymoma with WHO type B2-C and/or extraparenchymal extension, as similarly indicated for primary thymic epithelial tumors. A longer follow-up period may be needed in order to validate this strategy.
Follow-Up Studies ; Humans ; Neck* ; Radiotherapy ; Recurrence ; Retrospective Studies ; Thymoma ; Thymus Neoplasms* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; World Health Organization

Laryngeal cancers account for approximately 1.5% (1~2%) of the total cancers in Korea, and 30% of all head and neck cancers, not including thyroid cancer. Early laryngeal cancer is treated by operation, including transoral laser excision or radiotherapy. Advanced laryngeal cancer has been treated with mutilating operations, such as a total laryngectomy. However, a laryngeal preserving approach, which can improve the quality of life, has recently been tried with advanced laryngeal cancer.
Head ; Korea ; Laryngeal Neoplasms* ; Laryngectomy ; Laser Therapy ; Neck ; Quality of Life ; Radiotherapy ; Thyroid Neoplasms

PURPOSE: To Study the dosimetric advantage of the Jaw tracking technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for Head and Neck Cancers. MATERIALS AND METHODS: We retrospectively selected 10 previously treated head and neck cancer patients stage (T1/T2, N1, M0) in this study. All the patients were planned for IMRT and VMAT with simultaneous integrated boost technique. IMRT and VMAT plans were performed with jaw tracking (JT) and with static jaw (SJ) technique by keeping the same constraints and priorities for a particular patient. Target conformity, dose to the critical structures and low dose volumes were recorded and analyzed for IMRT and VMAT plans with and without JT for all the patients. RESULTS: The conformity index average of all patients followed by standard deviation (x¯±σ(x¯)) of the JT-IMRT, SJ-IMRT, JT-VMAT, and SJ-VMAT were 1.72 ± 0.56, 1.67 ± 0.57, 1.83 ± 0.65, and 1.85 ± 0.64, and homogeneity index were 0.059 ± 0.05, 0.064 ± 0.05, 0.064 ± 0.04, and 0.064 ± 0.05. JT-IMRT shows significant mean reduction in right parotid and left parotid shows of 7.64% (p < 0.001) and 7.45% (p < 0.001) compare to SJ-IMRT. JT-IMRT plans also shows considerable dose reduction to thyroid, inferior constrictors, spinal cord and brainstem compared to the SJ-IMRT plans. CONCLUSION: Significant dose reductions were observed for critical structure in the JT-IMRT compared to SJ-IMRT technique. In JT-VMAT plans dose reduction to the critical structure were not significant compared to the SJ-IMRT due to relatively lesser monitor units.
Brain Stem ; Head and Neck Neoplasms ; Head* ; Humans ; Jaw* ; Neck* ; Radiotherapy* ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Spinal Cord ; Thyroid Gland

To identify the effect of post-operative irradiation to the thyroid gland in patients with breast carcinoma. Seventy seven patients with partial or total mastectomized breast carcinoma who received routine irradiation therapy (Hockey stick method: supraclavicular, internal mammary lymph nodes, and chest wall irradiation with 5, 040 rads, divided into 30 treatments) were reviewed in terms of their ipsilateral thyroid gland response. All patients had the bilateral thyroid sizes measured annually by ultrasonography before and after radiation therapy. In the one-year follow-up group (n=77), 32 patients (41.5%) demonstrated decreased ipsilateral thyroid gland size after Hockey Stick irradiation therapy (p=0.428), in the two-year follow-up group (n=37), 26 patients (70.3%) demonstrated decreased gland size after Hockey Stick irradiation (p=0.001), and in the three-year follow-up group (n=21), 15 patients (71.4%) showed a decreased thyroid gland size (p=0.005). Most the patients with breast carcinoma (32/77 at the one-year follow-up, 26/37 at the two-year follow-up, and 15/21 at the three-year follow-up) after post-operative Hockey Stick irradiation therapy showed reduced ipsilateral thyroid gland size. Routine en face treatment of the supraclavicular lymph nodes, using the Hockey Stick method, should be reconsidered.
Breast Neoplasms/*radiotherapy ; Female ; Follow-Up Studies ; Human ; Lymph Nodes/*radiation effects ; Radiotherapy/adverse effects ; Thyroid Gland/pathology/*radiation effects