How do you treat locally advanced medullary thyroid cancer with postoperative RT?

What dose and fractionation is appropriate for medullary thyroid carcinoma with extrathyroid extension, bilateral cervical lymph node levels 2-5 with extranodal extension, paratracheal node involvement with extranodal extension, and thymus involvement s/p excision with positive margins throughout? Gross unresected disease remains in the mediastinum levels 4, 7, and bilateral hilar lymph nodes. Also what is the appropriate literature for treatment guidance?

1 Answer

Mednet MemberInvited Expert

Radiation Oncology · University of Michigan

Answered on

Medullary thyroid cancer typically presents with extensive LN metastases, and this case represents a typical very advanced case. Cases of more localized cancers which I have treated were characterized by adequate control of the irradiated disease, however, in all such patients disease progressed in lymph nodes beyond those treated. This case is not curable using radiotherapy, and the aim of radiotherapy here is purely palliative. If the patient is symptomatic, radiation should be delivered to disease causing symptoms. Dose and fractionation will depend on the tissue volumes irradiated: a faster course if limited, and a slower one if there is a need to treat extensively. There is no established dose/fractionation regimen. If the patient is n...

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