Chirurgie en 131I-nabehandeling bij patiënten met gedifferentieerde schildklierkanker in Zuidoost-Nederland, 1983-1996, vergeleken met de consensusrichtlijnen uit 1987

To evaluate the treatment of patients with differentiated (papillary or follicular) thyroid cancer in general hospitals in the south-east of the Netherlands during the period 1983-1996, in relation to the 1987 national consensus recommendations.

Design

Population-based, retrospective, descriptive.

Method

For the period 1 January 1983-31 December 1996, data on the histology, TNM-stage and treatment (hospital, specialist, type of operation, referral for ¹³¹I therapy) of all 236 patients with differentiated thyroid cancer were obtained from the cancer registry of the Comprehensive Cancer Centre South, Eindhoven, the Netherlands. The treatment was compared with the recommendations from the consensus meeting in 1987.

Results

Data on 219 patients (137 papillary, 82 follicular thyroid carcinoma) treated in the general hospitals in the region were studied; the 17 remaining patients had been referred from outside the region. Patients were treated at all hospitals in the region; the number of specialists per hospital able to treat thyroid carcinoma (internist and/or surgeon) was limited. In total 79 of the patients underwent a (near-)total thyroidectomy, half of them in two phases, and in 12 of the cases combined with regional lymph node dissection. In the majority of cases, surgical treatment was in accordance with the consensus recommendations: 65-100 of the cases per hospital. The proportion of patients referred for ¹³¹I therapy varied from 17 to 90; referral was more frequent in the case of larger tumours and/or metastases. Of the 24 patients with a small papillary carcinoma without metastases, 79 were not referred for ¹³¹I therapy.

Conclusions

The recommendations laid down in the consensus meeting in 1987 were known and appeared to be fol-lowed for surgical treatment but for subsequent ¹³¹I therapy they appeared to be interpreted differently. A review of the consensus guidelines seems to be worthwhile.