Medullary Thyroid Cancer: Advances and Challenges - Episode 6

Nonsurgical Treatment Options for Early-Stage MTC

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Outside of surgery, the initial treatment options for patients with early-stage medullary thyroid cancer (MTC) are limited, explains Eric J. Sherman, MD. Also, in terms of early prophylaxis, there are currently not any available treatment options.

In other types of head and neck cancer, radiation therapy is commonly applied; however, this approach is largely without supporting data for patients with MTC, stresses Lori J. Wirth, MD. As a result, it is important to consider the risks and benefits before initiating treatment for a patient with early-stage MTC. Following surgery, patients may live for a long time without experiencing recurrence and radiation may cause unneeded long-term toxicity.

Following surgery, the management and monitoring of patients relies heavily on the biomarkers CEA and calcitonin, states Steven I. Sherman, MD. Approximately 4 to 6 months following thyroidectomy, these markers will nadir. After this point, tests should be performed every 6 months.

If calcitonin levels are less than 200, an ultrasound of the neck is sufficient, suggests Steven Sherman. Additionally, serial scanning should be utilized to calculate marker doubling times. If the doubling time is greater than 2 years, the risk for aggressive disease is low. However, a doubling time of 6 months or less suggests the presence of residual disease, warranting more aggressive imaging.