What is included in long-term monitoring of medullary thyroid carcinoma (MTC)?

Updated: May 09, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

After receiving treatment for MTC, patients are monitored with annual measurement of serum calcitonin levels for surveillance. Pentagastrin-stimulated calcitonin testing is no longer widely available. Carcinoembryonic antigen is another tumoral marker associated with the recurrence of MTC, and it may also be used for surveillance. Patients with elevated levels of calcitonin or carcinoembryonic antigen are evaluated for recurrent disease. Neck, abdominal, and pelvic CT or MRI may be used to detect disease if metastasis or recurrence is suspected. Ultrasonography may be useful to localize cervical disease. In addition, radionuclide studies and selective venous catheterization with sampling of calcitonin levels can be performed to localize recurrences. The role of PET is evolving.

Radiation therapy is used in an adjuvant setting at some centers, and it can be used to treat patients with surgically inoperable recurrences and metastases. Because MTC does not concentrate iodine, radioiodine therapy has no role in follow-up care or treatment.

A variety of chemotherapeutic regimens have been used to treat metastatic disease. MTC is relatively insensitive to chemotherapy, though partial responses have been obtained. To date, the most effective combination is dacarbazine, vincristine, and cyclophosphamide. Adding doxorubicin to this regimen, some investigators have gained a partial response rate of about 35%.

Vandetanib (Caprelsa) and cabozantinib (Cometriq) are tyrosine kinase inhibitors approved by the US Food and Drug Administration (FDA) for progressive, metastatic medullary thyroid cancer. These agents target various tyrosine kinases, including MET, RET, and VEGFR-2.


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