Thyroid Cancer Treatments | Head and Neck Cancer | Thyroid Cancer Treatments
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The well differentiated papillary and follicular carcinomas are the most common; surgery provides the definitive thyroid cancer treatments, complemented by radioactive iodine. The anaplastic carcinomas are typically inoperable and therefore treated with external beam radiotherapy but rarely respond to chemotherapy. Medullary carcinoma in thyroid cancer treatment demands initial surgery and external beam irradiation is often required. For thyroid lymphoma external beam irradiation needs to be preceded by chemotherapy in some cases. In-patient facilities available for the treatment of thyroid cancers with radioactive iodine are available at the Royal Marsden Hospital as well as other hospitals in West and Central London. Dr Nutting works in close association with thyroid endocrinologists and thyroid surgeons to provide a breadth of experience in the management of thyroid cancer treatments. IMRT for thyroid cancer treatments For thyroid carcinoma, a conventional two-phase RT technique is used with the aim of homogeneous irradiation of the thyroid bed to 60 Gy and adjacent lymph nodes to 45-50 Gy. These aims frequently had to be compromised because the maximum dose to the spinal cord risked radiation damage (myelopathy). 3DCRT was found to significantly reduce the irradiated volume of normal tissue, but did not improve target coverage, and had no effect on the spinal cord maximum dose.  Figure 1. An IMRT dose distribution for thyroid cancer showing spinal cord sparing IMRT (Figure 1) reduced the dose to the spinal cord by 12% and achieved the goal PTV dose in all patients tested. Benefits of similar magnitude were achieved using nine, seven and five equispaced IMRT fields, but the use of fewer fields resulted in a significantly worse dose distribution. The first clinical protocol for head and neck IMRT treated the first patient in January 2002, and will explore the role of IMRT in thyroid cancer treatments the treatment of thyroid tumours, and other head and neck cancers when the planning target volume surrounds the spinal cord. In patients with tumours of the throat (larynx and pharynx) the protocol will investigate the role of higher doses of radiation delivered with IMRT. It is hoped that dose-escalation will improve local tumour control and reduce the need for laryngectomy, an operation to remove the voice-box, which causes loss of natural speech and leaves patients with a tracheostomy. This ICR/RMH protocol will be the first head and neck IMRT trial in the UK, and the first dose-escalation protocol of head and neck cancer IMRT in Europe. Data collected from these studies will provide a source of material for modelling the effects of radiation on normal tissues and tumours, which may be used to predict cure and complication rates in the future. |
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