Aims
In 1980 a Thyroid Cancer Clinic was set up at Royal Brisbane Hospital [RBH] to manage complex Thyroid Cancer patients. The clinic evolved management guidelines based on international best practice.
Methods
Patients with a new diagnosis of thyroid cancer were seen and discussed with their pathology and imaging. RBH is the only facility in Queensland offering high dose I131 for ablation and therapy. External beam radiation therapy is reserved for symptomatic disease not responsive to I 131 and poorly differentiated and anaplastic tumours.
Results
Since 1980 the population of Queensland has risen from 2.42 million to 4.56 million . The incidence of thyroid cancer has risen from 4.1 to 16.1 per 100,000 in females and 1.6 to 5.4 in males. The age range is from 7 to 91 . The clinic has managed 4158 patients.
The overall disease specific survival is 85% at 25 years. However for the majority in the well differentiated cohort [Papillary and Follicular] the survival rate is 87% . Significant multivariate survival variables are Sex [p=0.005, HR 0.68, 95%CI 0.52-0.89] Age [p=<0.001, HR1.05, 95%CI 1.04-1.06] T stage only T4 is significant [p=<0.001, HR 6.20,95%CI 4.01-9.57] M stage [p=<0.001,HR 4.13, 95%CI 3.02-5.67] Nodal disease approaches significance in the multivariate model [p=0.09, HR1.28, 95%CI 0.96-1.71] but is highly significant in an age partitioned univariate analysis .
Conclusion
Despite rapidly rising incidence mortality has remained stable.
Significant management changes include:
Functional neck dissection rather than “Berry Picking”
Raising the threshold for offering I 131 ablation
Use of recombinant TSH as conditioning for I131 ablation
The use of 1000MBq I 131 instead of 4000MBq as the standard ablation dose
Replacing follow up I 131 scans with tumour marker studies using Thyroglobulin
Utilising a risk adapted approach to thyroxine replacement.