[Teleradiotherapy in the treatment of thyroid neoplasms]

The role of external radiotherapy in the treatment of thyroid neoplasms is not yet well defined. The indications for loco-regional treatment in the case of: anaplastic carcinomas (alone or in combination with surgery or chemotherapy); differentiated and medullary carcinomas at diagnosis or relapse; nodes or osseous metastases not otherwise curable (surgery, hormones, brachytherapy); cerebral metastases; are accepted by everyone. Results, from the various clinical reports published, are positive. The use of this methodology is not accepted by everyone as "adjuvant" in cases "at risk" for micro or macroscopic residuals after surgery for papillary, follicular or medullary carcinomas. From the analysis of the literature, even a recent publication in relation to an apparent growing local control, we have no data in favour of increased survival. Even from our experience we cannot give definitive data (78.5% of local control in case of papillary or follicular carcinoma, survival of 57% in 5 years and 36% in 10 years). The question could be solved only by randomised trials but the difficulties due to the need for a sufficient number of cases and to the long "natural" survival, even in presence of disease, appear to be insuperable. We suggest a prudent approach, in controversial cases, because of the difficulties linked to the optimal loco-regional treatment (high doses, proximity of organs "at risk").