Followup Of Thyroid Cancers

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Although most patients survive DTC, lifelong follow-up is necessary because tumor recurrence is relatively common, and this may take many years to become clinically apparent. In our series of DTC patients followed up over a mean interval of 11.3 years, 20% of patients developed recurrence of tumor and 8.4% succumbed to the disease. When these data are plotted as cumulative survival curves

Figure 2-17. Papillary thyroid carcinoma with symptomatic bone metastases. A, Plain radiograph of the thoracolumbar spine showing partial destruction of T11 and T12 vertebral bodies, resulting in scoliosis. B, Total-body scan performed 72 hours after a high-dose (200 mCi) radioactive iodine (1311) therapy showing intense 1311 uptake in vertebral bodies (arrow) and lesser degrees of 131I uptake in the ribs and the skull (shorterarrows), indicating multiple sites of bony metastases. Unlike the case shown in Figure 2-15, this patient is unlikely to achieve complete treatment response. B, (1) anterior view, (2) posterior view. Courtesy of C. H. Goh, MD, Department of Nuclear Medicine, Singapore General Hospital, Singapore.

Figure 2-17. Papillary thyroid carcinoma with symptomatic bone metastases. A, Plain radiograph of the thoracolumbar spine showing partial destruction of T11 and T12 vertebral bodies, resulting in scoliosis. B, Total-body scan performed 72 hours after a high-dose (200 mCi) radioactive iodine (1311) therapy showing intense 1311 uptake in vertebral bodies (arrow) and lesser degrees of 131I uptake in the ribs and the skull (shorterarrows), indicating multiple sites of bony metastases. Unlike the case shown in Figure 2-15, this patient is unlikely to achieve complete treatment response. B, (1) anterior view, (2) posterior view. Courtesy of C. H. Goh, MD, Department of Nuclear Medicine, Singapore General Hospital, Singapore.

over 25 years by a Kaplan-Meier plot, the cumulative recurrence rate was about 40% and the cumulative cancer-specific death rate was about 20% (Figure 2-18).15 These data are consistent with other reports and underscore the need for clinical judgment and individualization in follow-up strategy, recognizing that surveillance should not be discontinued but may be performed less frequently when a decade or more has passed with no evidence of relapse.19,22

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