Treatment of locally invasive carcinoma of the thyroid: how radical?

Forty-seven patients with locally invasive thyroid carcinoma were treated at the M.D. Anderson Hospital over a 10 year period. The factors that adversely affected their survival included age, male sex, spindle and giant cell histology, and extensive involvement of adjacent structures in the neck. Surgical treatment aimed at removal of all gross tumor with preservation of vital structures whenever possible offers a reasonable chance of cure in locally aggressive well-differentiated thyroid cancer. Extensive ablative procedures are rarely indicated and do not improve survival. Radioactive iodine is beneficial in the treatment of well-differentiated lesions.