Thyroid & Adrenal
Treatment of medullary carcinoma thyroid
|A||Surgery and radiotherapy|
|B||Radiotherapy and chemotherapy|
a. Total thyroidectomy is the treatment of choice for patients with MTC because of the high incidence of multicentricity, the more aggressive course, and 131I therapy is not usually effective.
b. The central compartment nodes are frequently involved early in the disease process, so that a bilateral central neck node dissection should be routinely performed.
c. In patients with palpable cervical nodes or involved central neck nodes, ipsilateral or bilateral, modified radical neck dissection is recommended.
d. Similarly, patients with tumors larger than 1.5 cm should undergo ipsilateral prophylactic modified radical neck dissection, because greater than 60% of these patients have nodal metastases.
e. Approximately 30% of these patients will also have contralateral nodal metastases.
f. External beam radiotherapy is controversial, but is recommended for patients with unresectable residual or recurrent tumor. There is no effective chemotherapy regimen.
g. Tumors that express c-kit may also respond to tyrosine kinase inhibitors such as GleevecQ.