To Study the Impact of Radiation Treatment After Surgery in Patient With Locally Advanced Thyroid Cancer.
To Study the Impact of Radiation Treatment After Surgery in Patient With Locally Advanced Thyroid Cancer.
This trial deals with cancers of the thyroid gland which are advanced at the local site of
 thyroid. These cancers are treated with surgery and complete removal of the thyroid gland.
 But due to advanced nature, there is risk of re-occurrence. Radiotherapy can be used to
 prevent this re-occurrence. This study attempt to see the effect of radiotherapy in
 preventing re-occurrence and its side effects in advanced thyroid cancer.
Surgery, when possible offers the best chance of cure for cancer of the thyroid gland.
 Surgery for thyroid cancer involves removal of the thyroid gland along with removal of the
 lymph nodes which drain the gland. After surgery most patients will receive radio-iodine
 treatment to diagnose and treat any spread of the cancer in the body. Most thyroid cancers
 will have good outcomes with the above mentioned treatment. However, in advanced thyroid
 cancer there is a higher chance of recurrence even with surgery and radio iodine. Surgery for
 recurrence of these cancers is very morbid This may entail surgeries which may also involve
 removing portions of the voice box and food pipe. You may therefore develop and discomfort or
 inability to eat or speak.

 Radiation therapy can be given to the neck along with radio-iodine therapy to decrease these
 re occurrences of the cancer. A number of studies have shown a benefit with the use of
 radiation therapy in advanced cases of thyroid cancer. However, the side effects of
 radiation, if any, have not been well documented. This study is being done to assess the
 impact of radiation on the outcome of cancer and the exact side effects of radiation therapy.
 If the side effects are not too many, then radiation therapy can be used to decrease the
 chances of recurrence in the neck after thyroid.

 In this study, patients undergoing total thyroidectomy for thyroid cancer will be assessed
 for high risk features on the histopathology report and the intra operative findings. Those
 with advanced thyroid cancer as per the eligibility criteria will be counselled and consented
 for the study. Those patients willing to participate in the study will be randomised to
 either receive only surgery and radio-iodine or surgery, radio-iodine and external beam
 radiation.
Inclusion Criteria:

 A) All patients of differentiated thyroid cancer (papillary/follicular/poorly
 differentiated/) who have undergone total/completion thyroidectomy at our institute and
 having at least two of the following features (listed below) intra-operatively and/or on
 histopathology

 1. Gross extrathyroidal spread into soft tissues of the neck, trachea, esophagus,
 recurrent laryngeal nerve (constituting stage T4a)

 2. R1/ shave resections (minimal residual disease)

 3. R2 resections (gross residual disease)

 4. Multiple lymph nodes positive(>2) with perinodal extension at level VI B) Normal
 baseline haematological and biochemical parameters.

 Exclusion Criteria:

 1. Anaplastic or medullary thyroid cancer

 2. Previous history of radiation

 3. Pregnancy

 4. < 18 years Patient unwilling to participate in the study.