Researchers from Guangzhou, China discovered primary tumor resection (PTR) to be an appropriate intervention with good performance status in patients with medullary thyroid carcinoma (MTC) who had unresectable synchronous distant metastases, according to a study published in Head & Neck.

The ultimate goals of surgical intervention in MTC are to increase disease-free survival and to prevent any locoregional recurrence. However, the role of surgical intervention in MTC patients with unresectable synchronous distant metastases is under much debate. The question revolves around which management strategy has the best outcomes: PTR or administering nonsurgical methods followed by surgical removal of metastatic lesions. PTR is usually reserved for palliative treatment in these cases, but studies on other metastatic cancers have shown that it can improve survival outcomes. 

Researchers therefore wanted to investigate the survival outcomes of MTC patients with unresectable synchronous distant metastases who underwent PTR. They conducted a retrospective study on patients with MTC who were registered in the Surveillance, Epidemiology, and End Results (SEER) registry. A total of 164 patients diagnosed with MTC between 1998 and 2015 were deemed eligible for this study. 

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The results show that patients with MTC who underwent PTR had lower overall mortality than the group that did not. The survival rates of patients who underwent PTR were also encouraging: the overall and cancer-specific survival rates at the first-, third-, and fifth-year marks were significantly higher in the PTR group than in the non-PTR group. 

The authors of the study wrote, “Our investigation provided clear evidence that PTR was associated with superior overall and cancer-specific survival in a large patient cohort.”

This study shows that although the anterior surgical approach may not be the currently favored management strategy, it can significantly improve survival. Therefore, the authors recommend that patients with metastatic MTC be managed in a multidisciplinary setting that includes surgery to achieve the best clinical outcomes. 


Zhuang SM, Xie LE, Pang F, et al. Role of primary tumor resection in patients with metastatic medullary thyroid cancer who have unresectable distant metastases. Head Neck. Published online August 23, 2021. doi:10.1002/hed.26840