30. Kết quả xạ trị sau phẫu thuật trên bệnh nhân ung thư tuyến giáp thể tủy tại Bệnh viện K

Abstract

Medullary thyroid cancer accounts for only 3 - 5% of all thyroid cancers. Surgery remains the most essential treatment modality, with radiation therapy playing a role in selected cases as an adjuvant for high-risk situations (extrathyroidal extension, positive surgical margin, multiple neck node metastases), and for symptomatic relief when surgery is not feasible. This study is a retrospective analysis of 21 patients with medullary thyroid cancer who underwent surgery and radiation therapy at Viet Nam National Cancer Hospital from January 2018 to December 2023. The aim was to evaluate the outcomes of radiation therapy in this patient cohort.All patients in study underwent total thyroidectomy with neck node dissection. Extrathyroidal extension and neck node metastases were the most common high-risk factors, accounting for 57.1%. Four patients had R2 resection margins post-surgery and received a radiation dose of 70 Gy, while the remaining patients received total radiation doses ranging from 60-66 Gy. Most patients were treated using 3D techniques (76.2%). Acute radiation complications commonly included dermatitis, whereas late complications included neck fibrosis and esophageal stricture The 5-year overall survival rate was 90.5%. After 5 years of follow-up, there was a 76.2% recurrence rate. Factors influencing overall survival (OS) and event-free survival (EFS) include positive surgical margins, gross extrathyroidal extension, lymph node metastasis, and interruption of radiotherapy. The 3D technique was predominantly used, accounting for 76.2%. Adjuvant radiotherapy doses ranged from 60 to 70Gy, depending on the risk factors. The study concludes that radiation therapy can control medullary thyroid cancer post-surgery, with acceptable side effects.