Thyroid Cancer
Thyroid cancer is uncommon and only represents 1% of all diagnosed malignancies and 0.2% of cancer deaths in the USA. The incidence is increasing in part due to a better detection of subclinical disease with imaging studies in the past years. Papillary ca
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Thyroid Cancer Mauricio Gamez, Aman Anand, and Samir H. Patel
Contents 9.1 9.2 9.3 9.4
Introduction..................................................................................................................... 165 Simulation, Target Delineation, and Radiation Dose/Fractionation............................... 166 Patient Positioning, Immobilization, and Treatment Verification................................... 167 Three-Dimensional (3D) Proton Treatment Planning..................................................... 168 9.4.1 Passive Scattering (PS)....................................................................................... 168 9.4.2 Pencil Beam Scanning (PBS).............................................................................. 169 9.5 Dosimetric and Toxicity Comparison............................................................................. 173 9.6 Future Developments...................................................................................................... 173 References................................................................................................................................ 174
9.1
Introduction
Thyroid cancer is uncommon and only represents 1% of all diagnosed malignancies and 0.2% of cancer deaths in the USA. The incidence is increasing in part due to a better detection of subclinical disease with imaging studies in the past years. Papillary cancer is the most common thyroid malignancy and represents approximately 80% of all thyroid cancers. Follicular cancer represents approximately 10%, and the remaining 10% of thyroid tumors are medullary, anaplastic, and others. Most commonly, it affects females rather than males with a 3:1 relationship. The majority of thyroid tumors are primarily managed with surgery followed by ± radioactive iodine (RAI) in those with a differentiated thyroid cancer (DTC). Patients with anaplastic carcinoma should be immediately referred and
M. Gamez • A. Anand • S.H. Patel (*) Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA e-mail: [email protected] © Springer International Publishing Switzerland 2018 N. Lee et al. (eds.), Target Volume Delineation and Treatment Planning for Particle Therapy, Practical Guides in Radiation Oncology, https://doi.org/10.1007/978-3-319-42478-1_9
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have multidisciplinary management in a tertiary cancer center due to the dismal prognosis of the disease [1–3]. The role of external beam radiation therapy (EBRT) in the treatment of DTC is controversial because of a lack of prospective trials and conflicting results in the existing retrospective data [4–6]. The Endocrine Surgery Committee of the American Head and Neck Society recommends EBRT for locoregional control in DTC for patients with gross residual or unresectable locoregional disease, except for patients 45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. EBRT should not be routinely used as adjuvant the
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