From the Guidelines
Metastatic Hurthle cell carcinoma patients have a poor prognosis, and treatment should focus on improving survival rates and quality of life, with 5-year survival rates ranging from 30-50%. The most recent and highest quality study, 1, provides guidance on the management of differentiated thyroid cancer, including Hurthle cell carcinoma. According to this study, Hurthle cell carcinoma has distinct clinical, biological, and genetic features that justify its recognition as a distinct type of differentiated thyroid cancer.
Treatment Options
- Surgery is an option when possible, although Hurthle cell carcinomas are often less responsive to radioactive iodine therapy than other thyroid cancers.
- External beam radiation and systemic therapies may also be considered.
- For patients with progressive metastatic disease, targeted therapies like sorafenib (400mg twice daily) or lenvatinib (24mg daily) are recommended as first-line options, as they work by blocking pathways involved in tumor growth and angiogenesis, as noted in 1.
- Pembrolizumab (200mg IV every 3 weeks) may be considered for tumors with high microsatellite instability.
Monitoring and Follow-up
- Close monitoring with regular thyroglobulin measurements, neck ultrasounds, and periodic cross-sectional imaging is essential, as emphasized in 1.
- Treatment is typically continued until disease progression or intolerable side effects occur.
- Side effect management is crucial, including blood pressure monitoring, skin care, and thyroid function tests.
Clinical Trials
- Clinical trials should be considered when available, as research into more effective treatments for this rare and aggressive cancer continues, as highlighted in 1.
Overall, the management of metastatic Hurthle cell carcinoma requires a multidisciplinary approach, with a focus on improving survival rates and quality of life, as noted in 1.
From the Research
Metastatic Hurthle Cell Carcinoma Survival
- The survival rate of patients with metastatic Hurthle cell carcinoma can be influenced by various factors, including treatment options such as radioactive iodine (RAI) therapy.
- A study published in 2016 found that RAI treatment was associated with improved survival rates for patients with Hurthle cell carcinoma, with a 30% reduction in mortality 2.
- Another study from 2017 reported favorable outcomes for patients with Hurthle cell carcinoma who were treated with total thyroidectomy, RAI, and selective use of external-beam radiotherapy, with a 5-year actuarial overall survival rate of 92% 3.
- However, a more recent study from 2022 found that RAI therapy did not improve cancer-specific survival in patients with Hurthle cell carcinoma, even in those with aggressive features such as distant disease or lymph node metastases 4.
- The role of RAI in the treatment of metastatic Hurthle cell carcinoma is still debated, with some studies suggesting that it may be effective in certain cases, such as when the tumor accumulates RAI 5.
Treatment Options
- Total thyroidectomy is a common treatment option for Hurthle cell carcinoma, often followed by RAI therapy to ablate any remaining thyroid tissue.
- External-beam radiotherapy may also be used in selected cases, such as when there is evidence of distant metastases or recurrent disease.
- The decision to use RAI therapy should be made on a case-by-case basis, taking into account the individual patient's characteristics and the potential benefits and risks of treatment.
Prognosis
- The prognosis for patients with metastatic Hurthle cell carcinoma varies depending on several factors, including the extent of disease, the presence of distant metastases, and the effectiveness of treatment.
- Overall, the 5-year survival rate for patients with Hurthle cell carcinoma is around 80-90%, although this can vary depending on the specific characteristics of the patient and the disease 2, 3.