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Current approaches and perspectives in the therapy of medullary thyroid carcinoma
G Vitale1, M Caraglia, A Ciccarelli
1Department of Molecular and Clinical Endocrinology and Oncology, School of Medicine, University of Naples Federico II, Naples, Italy.
Background:
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor derived from parafollicular cells. At present, surgery is the most important treatment for MTC.
Methods:
We describe the current approaches of MTC treatment (surgery, chemotherapy, radiation therapy, and biologic therapy).
Results:
MTC is currently approached surgically in the main part through total thyroidectomy and compartment-oriented microdissection of cervicomediastinal lymph nodes. Substitutive l-thyroxine administration together with close clinical monitoring and the measurement of basal and stimulated serum calcitonin are subsequently performed. Radiotherapy and chemotherapy play a marginal role in advanced MTC. Recently, it has been found that somatostatin analogs and type I interferon are able to control the neuroendocrine symptoms induced by advanced MTC and that they provide clinical benefit by improving the lifestyle of these patients.
Conclusion:
Although these agents are poorly active in inducing a shrinkage in tumor mass, the combined use of different biologic agents and cytotoxic drugs needs to be explored in advanced MTC. However, at present, surgery is the only curative treatment for MTC.