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Chen S, Xu L, Pan S, Chen G. Impact of distant metastasis on overall survival and cancer specific survival of elderly patients with differentiated thyroid cancer. Sci Rep 2024; 14:24855. [PMID: 39438552 PMCID: PMC11496556 DOI: 10.1038/s41598-024-76613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 10/15/2024] [Indexed: 10/25/2024] Open
Abstract
Distant metastases are common in most elderly patients, because elderly patients are diagnosed with advanced thyroid cancer due to delayed diagnosis. There is still few specific real-world data regarding prognosis in the elderly with differentiated thyroid cancer (DTC). The purpose of this study is to evaluate the prognostic factors and survival rate of elderly DTC patients with metastasis. This retrospective study included 14,603 elderly patients diagnosed with DTC from 2010 to 2015, including 447 patients with distant metastasis via the Surveillance, Epidemiology and End Results (SEER) database. The prognostic factors of overall survival (OS) and cancer-specific survival (CSS) in elderly DTC patients with metastasis or non-metastasis were determined by univariate and multivariate analysis. Age, primary site operation, radiotherapy, chemotherapy and tumor size are associated with OS and CSS in elderly DTC patients with distant metastasis. Compared with the patients without surgery, patients with total thyroidectomy showed significantly better OS. For the elderly DTC patients, radiotherapy was associated with improving OS and CSS. Chemotherapy increased the risk of death. For elderly DTC patients, early identification of distant metastasis, total thyroidectomy and radiotherapy are associated with better prognosis.
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Affiliation(s)
- Shuqian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Lizhen Xu
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Shuyao Pan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China.
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Leland CR, Gonzalez MR, Werenski JO, Vallone AT, Brighton KG, Newman ET, Lozano-Calderón SA, Raskin KA. What Factors Are Associated With Implant Revision in the Treatment of Pathologic Subtrochanteric Femur Fractures? Clin Orthop Relat Res 2024:00003086-990000000-01775. [PMID: 39437551 DOI: 10.1097/corr.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 10/04/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Limiting reoperation or revision after operative stabilization or endoprosthetic reconstruction of a pathologic subtrochanteric femur fracture reduces morbidity, but how best to achieve this remains controversial. Endoprosthetic reconstruction offers durable mechanical stability but may not be most appropriate in patients who are frail or who are not expected to survive more than a few months. For that reason, cumulative incidence survival (looking at the endpoint of reoperation or revision with death as a competing risk) and factors associated with revision after surgical stabilization or reconstruction-both of which remain poorly characterized to date-would help surgeons make better decisions on behalf of these patients. QUESTIONS/PURPOSES We analyzed patients who were operatively treated for pathologic subtrochanteric femur fracture, and we asked: (1) What is the cumulative incidence of reoperation and revision at 3 months, 1 year, and 2 years after surgery for pathologic subtrochanteric femur fracture in patients undergoing each treatment type with death as a competing risk? (2) What are the factors associated with implant revision after operative treatment of pathologic subtrochanteric femur fracture? (3) What is the overall survival of patients in this population after surgery? (4) How do clinical and surgical factors along with the frequency of complications compare in this population by operative treatment? METHODS Between January 2000 and December 2020, 422 patients underwent surgery for completed proximal femur pathologic fractures. After excluding patients with non-subtrochanteric femur fractures (71% [301]), fractures caused by primary tumors of bone (< 1% [2]), and insufficient data (1% [6]), we included 113 patients who underwent operative treatment of completed pathologic subtrochanteric femur fractures. Our study period spanned 20 years because although implant trends may have shifted, the overall operative objective for pathologic subtrochanteric femur fractures-restoring function and alleviating pain, regardless of the extent of bony union-have remained relatively unchanged during this period. Median follow-up time was 6 months (range 1 month to 20.6 years). Intramedullary nailing (IMN) was performed in 68% (77) of patients, proximal femur replacement (PFR) was performed in 19% (22), and open reduction and internal fixation (ORIF) was performed in 12% (14) of patients. IMN was performed in patients with a poor prognosis but in whom fracture stabilization was felt to be advantageous. In instances of complex fractures in which adequate reduction could not be achieved, ORIF was generally performed. PFR was generally performed in patients with a better prognosis in which long-term implant survival and patient function were prioritized. We found a higher proportion of women in the IMN group (73% versus 32% in PFR and 50% in ORIF; p = 0.001). Rapid growth tumors (Katagiri classification) were found in 25% of patients with IMN, 27% with PFR, and 43% with ORIF. The primary outcome was the cumulative incidence of reoperation or revision surgery after initial stabilization. Competing risk analysis with death as a competing event was performed to estimate the cumulative incidence for reoperation and revision. Factors associated with revision surgery were identified using the Cox proportional hazards model, which rendered HRs. All analyses were adjusted to control for potential confounders. RESULTS The cumulative incidence for reoperation at 2 years was 5% (95% confidence interval [CI] 4% to 6%) for IMN, 15% (95% CI 9% to 22%) for PFR, and 32% (95% CI 15% to 50%) for ORIF (p = 0.03). The cumulative incidence for revision at 2 years was 4% (95% CI 3% to 4%) for IMN, 4% (95% CI 2% to 6%) for PFR, and 33% (95% CI 15% to 51%) for ORIF (p = 0.01). Factors associated with revision surgery were radioresistant tumor histology (HR 8.5 [95% CI 1.2 to 58.9]; p = 0.03) and ORIF (HR 6.3 [95% CI 1.5 to 27.0]; p = 0.01). The 3-month, 1-year, and 2-year overall survival was 80% (95% CI 71% to 87%), 35% (95% CI 26% to 45%), and 28% (95% CI 19% to 36%), respectively. Thirty-day postoperative complications did not differ by fixation type, but 90-day readmission was highest after ORIF (3 of 14 versus 4 of 22 in PFR and 4% [3 of 77] in IMN; p = 0.03) Periprosthetic joint infection (PJI) was more common after salvage PFR (2 of 6) than primary PFR (1 of 22) (p = 0.04). CONCLUSION Primary PFR may be preferred for pathologic subtrochanteric femur fractures arising from radioresistant tumor types, as the cumulative incidence of revision was no different than for IMN while restoring function, alleviating pain, and offering local tumor control, and it less commonly develops PJI than salvage PFR. In complex fractures not amenable to IMN, surgeons should consider performing a PFR over ORIF because of the lower risk of revision and the added benefit of replacing the pathologic fracture altogether and offering immediate mechanical stability with a cemented endoprosthesis. Future studies might evaluate the extent of bone loss from local tumor burden, and this could be quantified and analyzed in future studies as a covariate as it may clarify when PFR is advantageous in this population. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Christopher R Leland
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Marcos R Gonzalez
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph O Werenski
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony T Vallone
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kirsten G Brighton
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erik T Newman
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderón
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin A Raskin
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chua WM, Tang CYL, Loke KSH, Lam WWC, Yang SP, Lee MS, Hou W, Lim MYS, Lim KC, Chen RC. Differentiated Thyroid Cancer after Thyroidectomy. Radiographics 2024; 44:e240021. [PMID: 39235963 DOI: 10.1148/rg.240021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
The widespread use of neck US and other imaging modalities has contributed to a phenomenon of increased detection of differentiated thyroid cancer (DTC). Most of these cancers remain indolent, without requiring surgical intervention. Nonetheless, a subset of patients who require surgical treatment experience subsequent disease recurrence. This most commonly occurs in the cervical lymph nodes and thyroid bed, followed by distant metastasis to the lungs and bones. Because imaging is an integral part of postoperative surveillance, radiologists play a central role in the detection of recurrent tumors and in guiding treatment in these patients. US is the primary imaging modality used for postoperative evaluation. Other modalities such as CT, MRI, radioactive iodine imaging, and PET/CT aid in the accurate diagnosis and characterization of recurrent disease. Therefore, radiologists must have a thorough understanding of the utility of these imaging techniques and the imaging characteristics of recurrent DTC when interpreting these multimodality studies. The interpretation of imaging findings should also be correlated with the clinical status of patients and their biochemical markers to minimize interpretative errors. The authors present a broad overview of the postoperative evaluation of DTC, including its initial primary management, staging, and prognostication; clinical risk stratification for recurrent disease; postoperative surveillance with imaging and evaluation of biochemical markers; and management of recurrent DTC. Published under a CC BY 4.0 license. Supplemental material is available for this article.
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Affiliation(s)
- Wei Ming Chua
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Charlene Yu Lin Tang
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Kelvin S H Loke
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Winnie Wing-Chuen Lam
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Samantha Peiling Yang
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Melissa Shuhui Lee
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Wenlu Hou
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - May Yi Shan Lim
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Kheng Choon Lim
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Robert Chun Chen
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
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Hoff AO, Chaves ALF, de Oliveira TB, Ramos HE, Penna GC, Dos Santos LV, Maia AL, Brito DO, Vizzotto FP. Differentiated thyroid carcinoma: what the nonspecialists needs to know. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230375. [PMID: 38427812 PMCID: PMC10948043 DOI: 10.20945/2359-4292-2023-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 03/03/2024]
Abstract
Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents.
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Affiliation(s)
- Ana O Hoff
- Disciplina de Endocrinologia e Metabologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil,
| | | | | | - Helton Estrela Ramos
- Departamento de Biorregulação, Instituto de Saúde e Ciências, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Gustavo Cancela Penna
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Lucas Vieira Dos Santos
- Unidade de Câncer de Cabeça e Pescoço, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Ana Luiza Maia
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Gu T, Zhao Z, Shi Y, Sun Z, Wang Y, He Z, Wang K. Case report: A case of hyperthyroidism secondary to bone metastasis of differentiated thyroid cancer. Front Oncol 2024; 14:1354872. [PMID: 38469243 PMCID: PMC10927059 DOI: 10.3389/fonc.2024.1354872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
It is usually believed that differentiated thyroid cancer is less likely to have distant metastases and rarely occurs secondary to hyperthyroidism. In our case report, we describe a patient diagnosed with thyroid fetal adenoma in 2002 who subsequently presented with a painful lump in her right rib. Through puncture biopsy, the mass was considered as metastatic follicular thyroid carcinoma, and then she appeared to have hyperthyroidism. The results of SPECT examination and other tests suggested that the hyperthyroidism was secondary to the thyroid cancer. The patient further underwent total thyroidectomy, and the pathology did not find any follicular thyroid foci. In this article, we analyze and discuss this case and review the relevant literature.
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Affiliation(s)
- Tingyu Gu
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhihong Zhao
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yuanyuan Shi
- Department of Pathology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhenhua Sun
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yao Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiyuan He
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Kun Wang
- Department of Breast and Thyroid Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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Nourbakhsh S, Salehi Y, Farzanehfar S, Ghaletaki R, Bakhshi Kashi M, Abbasi M. FAPI PET/CT provides higher uptake and better target to back ground in recurrent and metastatic tumors of patients with Iodine refractory papillary thyroid cancer compared with FDG PET CT. Nuklearmedizin 2024. [PMID: 38190996 DOI: 10.1055/a-2185-7746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE The role of fibroblast activation protein inhibitor (FAPI) PET CT scan is not well documented in papillary thyroid cancer (PTC) patients. Patients with radioiodine refractory PTC and high thyroglobulin levels need PET/CT scan which is generally done by 18F FDG. In the current study, the diagnostic performance of 68Ga FAPI and FDG PET/CT scans were compared head to head in patients with radioiodine refractory PTC. METHOD Fourteen patients with negative whole body Iodine scans and high thyroglobulin levels underwent whole body PET scans with, respectively, 120-310 and 145-370 MBq 68Ga FAPI-46 and 18F FDG. SUVmax of the back ground in the blood pool and liver and the hottest, largest and average neck, mediastinum, lung and bone lesions were calculated and compared. RESULT Ten patients had at least one active (SUVmax>blood pool) lesion similarly in two scans. The liver and blood pool SUVmax values were 1.25(0.2) and 1.7(0.2) in FAPI and 2.65(0.2) and 2.0(0.2) in FDG PET images, respectively. The difference was significant (p=0.001). Standard SUV of the hottest lesion to liver was above 3 in all FAPI scans but in half of FDG scans. Target lesion number and intensity were similar between two PET studies but in a patient out of 5 pulmonary metastatic patients, pulmonary nodules were negative (SUVmax=0.9) in FDG while positive (SUVmax= 3.8) in FAPI images (i.e. 20% patient upstaged). CONCLUSION FAPI accumulates in the recurrent and metastatic lesions of patients with Iodine refractory PTC at least as well as FDG with particular privileges as lower injected activity and lower back ground.
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Affiliation(s)
| | - Yalda Salehi
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Saeed Farzanehfar
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Reza Ghaletaki
- Department of Radiation oncology, Imam Khomeini Hospital Complex, Tehran, Iran
| | | | - Mehrshad Abbasi
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran, Iran
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Kanankulam Velliangiri S, Ballal S, Prasad Yadhav M, Tripathi M, Satapathy S, Bal C. A long-term retrospective cohort-based risk-benefit analysis of augmenting total cumulative I-131 activity to 37GBq in differentiated thyroid cancer patients with skeletal metastases. PLoS One 2023; 18:e0294343. [PMID: 37963164 PMCID: PMC10645322 DOI: 10.1371/journal.pone.0294343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Skeletal metastases in differentiated thyroid cancer (DTC) patients are associated with poor prognosis. The objective was to determine the maximum I-131 cumulative activity that could be safely administered without compromising efficacy. The secondary objective was to identify other prognostic factors affecting survival outcomes. MATERIALS AND METHODS This was a retrospective cohort study done at a tertiary-care institution comprising of data from January 1990-June 2020. 489 DTC patients having skeletal metastases with ≥12 months follow-up were included. Ninety-six percent of patients had thyroidectomy followed by radioiodine therapy for skeletal metastases. All patients were on oral suppressive levothyroxine tablets. External beam radiotherapy (EBRT) and oral tyrosine kinase inhibitors were used whenever indicated. The main outcome measures were overall survival (OS), progression-free survival (PFS), and adverse-events. RESULTS There were 347 (71%) females and 324 (66%) had follicular carcinoma thyroid. Median follow-up was 78 (interquartile range, IQR: 37-153) months. 333 patients (68%) received ≤37GBq I-131 cumulative activity (group 1) and 156 patients (32%) received >37GBq cumulative RAI activity (group 2). Overall median OS and PFS were 74 (95% confidence interval (CI): 62.2-85.8) and 48 (95%CI: 40.5-55.4) months, respectively. The 5-, 10-, 15- and 20-year estimated overall survival probabilities were 55.7%, 28.4%, 14% and 8.3%, respectively. On multivariate analysis, age(<55years) (p<0.001), female gender(p = 0.01), cumulative I-131 activity >37GBq (p<0.001) and EBRT(p = 0.001) were favourably associated with OS; no factors were significantly associated with PFS. The median OS for groups 1 & 2 were 51 versus 90 months (p<0.001) & median PFS for groups 1 & 2 were 45 versus 53 months respectively (p = 0.9). However, cumulative activity >37GBq resulted in more adverse events (2.4%), particularly bone marrow suppression (3.5%). CONCLUSION For better survival outcomes, cumulative I-131 activity upto 37GBq could be administered with acceptable toxicity to DTC patients with skeletal metastases.
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Affiliation(s)
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Prasad Yadhav
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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8
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Chandra WD, Munir G. Unusual metastasis of papillary thyroid carcinoma to the spine: A case report. Radiol Case Rep 2023; 18:4110-4114. [PMID: 37720920 PMCID: PMC10504457 DOI: 10.1016/j.radcr.2023.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma and generally has an excellent prognosis. However, there are few cases of distant metastasis, especially to the spine, which are associated with significantly worse outcomes. Here, we present a 40-year-old male with back pain and weakness in both legs. The patient also complained of neck masses months prior to the neurological symptoms. On investigations, he was found to have multiple vertebral lesions with histopathology results of papillary thyroid carcinoma metastasis.
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Affiliation(s)
- Wenny Dwi Chandra
- Department of Radiology, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
| | - Gustiara Munir
- Department of Radiology, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
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9
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Elshafie O, Jain A, Bichpuria S, Rassou Y, Hashmi SF, Bou Khalil A. Calcaneus metastasis: a rare presentation of poorly differentiated thyroid cancer. Endocrinol Diabetes Metab Case Rep 2023; 2023:23-0103. [PMID: 38054478 PMCID: PMC10762545 DOI: 10.1530/edm-23-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Summary A 60-year-old woman presented to our clinic with an acute onset 3 months history of right ankle pain. The patient had a history of poorly differentiated thyroid cancer, which was treated with total thyroidectomy, left lateral neck dissection levels II-V and central neck dissection levels VI-VII followed by postoperative I-131 radioactive iodine (131I) ablation therapy 3.7 GBq 6 months ago. The post-131I WBS showed residual iodine-avid thyroid tissue with no other iodine-avid disease or metastasis. SPECT/CT of the neck and chest showed nonavid bilateral pulmonary nodules, discrete nodal masses in mediastinum and nonavid bone lesions. FDG-PET CT scan showed FDG-avid mediastinal lymph nodes (LN), innumerable non-FDG-avid subcentimetric pulmonary nodules and few FDG-avid lytic lesions in the skeleton. X-ray and MRI of the right ankle showed a well-marginated lytic lesion in the posterior body of calcaneus and 5 × 6 cm soft tissue mass lesion, respectively. The histopathology of the calcaneus mass confirmed a positive immunostaining for thyroid origin which includes thyroglobulin and TTF-1 with PAX-8. Endobronchial mediastinal and bronchial LN biopsy confirmed thyroid cancer metastasis. Gene mutation showed HRAS and GNA13 with a high tumor mutational burden. We describe a rare case of poorly differentiated thyroid cancer in a patient who presented with right ankle pain; we confirmed the cause to be a calcaneus metastasis from the thyroid cancer, with calcaneus being an extremely rare site for bone metastases. Gene mutations points toward treatment with immune checkpoint inhibitors. Learning points Poorly differentiated thyroid carcinoma (PDTC) usually metastasizes to lung and bone but can rarely occur in the calcaneus. Patients with distant metastases have significantly worse long-term prognosis. Radiotherapy is effective in reducing the metastatic pains as well as reducing the size of the metastasis. PAX-8 staining can be used to differentiate thyroid carcinomas from lung adenocarcinomas. The importance of searching for gene mutations to decide the treatment of PDTC.
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Affiliation(s)
- Omayma Elshafie
- Department of Endocrinology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Anjali Jain
- Department of Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Summit Bichpuria
- Department of Radiology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Yamina Rassou
- Department of Pathology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Syed Furqan Hashmi
- Department of Radiation Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Abir Bou Khalil
- Department of Endocrinology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
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10
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Khired ZA, Hussein MH, Jishu JA, Toreih AA, Shaalan AAM, Ismail MM, Fawzy MS, Toraih EA. Osseous Metastases in Thyroid Cancer: Unveiling Risk Factors, Disease Outcomes, and Treatment Impact. Cancers (Basel) 2023; 15:3557. [PMID: 37509220 PMCID: PMC10377410 DOI: 10.3390/cancers15143557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Bone is the second most common site of metastasis in patients with thyroid cancer (TC) and dramatically impacts overall survival and quality of life with no definitive cure, yet there is no extensive study of the demographic and clinical risk factors in the recent literature. Data regarding 120,754 TC patients with bone metastasis were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were used to identify the risk factors of bone metastasis occurring in various histologies of TC. Cox regression was performed to analyze the influence of bone metastasis on overall survival. Hazard ratios were computed to analyze the association between bone metastasis and the primary outcomes. Of the 120,754 records collected from the SEER database from 2000 to 2019, 976 (0.8%) presented with bone metastasis, with occurrence being the greatest in patients of age ≥ 55 years (OR = 5.63, 95%CI = 4.72-6.71), males (OR = 2.60, 95%CI = 2.27-2.97), Blacks (OR = 2.38, 95%CI = 1.95-2.9) and Asian or Pacific Islanders (OR = 1.90, 95%CI = 1.58-2.27), and single marital status. TC patients presenting with bone metastasis (HR = 2.78, 95%CI = 2.34-3.3) or concurrent bone and brain metastases (HR = 1.62, 95%CI = 1.03-2.55) had a higher mortality risk. Older age, gender, race, and single marital status were associated with bone metastasis and poorer prognosis in TC patients at initial diagnosis. Understanding such risk factors can potentially assist clinicians in making early diagnoses and personalized treatment plans, as well as researchers in developing more therapeutic protocols.
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Affiliation(s)
- Zenat Ahmed Khired
- Department of Surgery, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammad H Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jessan A Jishu
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ahmed A Toreih
- Department of Orthopedic Surgery, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Aly A M Shaalan
- Department of Anatomy, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Mohammed M Ismail
- Department of Anatomy, Faculty of Medicine, Northern Border University, Arar 91431, Saudi Arabia
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 91431, Saudi Arabia
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Suez Canal University, Ismailia 41522, Egypt
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11
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Liu X, Hu P, Zhai S, Liu X, Wang B, Zhou H, Liu X, Liu Z, Wei F. Surgery for metastatic spinal differentiated thyroid cancer: feasibility, outcome, and prognostic factors. Front Surg 2023; 10:1140150. [PMID: 37273828 PMCID: PMC10232895 DOI: 10.3389/fsurg.2023.1140150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Study design A retrospective cohort study. Objectives This study aims to report the surgical outcome of metastatic spinal differentiated thyroid cancer (MSDTC) and analyze the factors affecting the prognosis. Methods Thirty-five patients were recruited in our single institution who underwent spinal surgery and adjuvant therapies from 2009 to 2019. Two surgical procedures, total en-bloc spondylectomy and debulking surgery, were undertaken. Their clinical data, postoperative events, and survival data were collected and analyzed. Survival time and associated factors were further analyzed. Results The cohort had a median survival time of 60 months. The mean visual analog scale scores and the Karnofsky performance score improved postoperatively (p < 0.05). The patients' Frankel grade was elevated for cases with preoperative neurological deficits (p < 0.05). In 31 patients who underwent debulking surgery, 41.9% (n = 13) had local recurrences, and radiotherapy reduced the risk of local relapse (p < 0.05). Preoperative and postoperative Frankel grades and radioactive iodine (RAI) therapy were associated with the patients' survival in the univariate analysis (p < 0.05). Furthermore, a multivariate regression analysis showed the postoperative Frankel grade as an independent prognostic factor. Conclusion Pain, quality of life, and neurological status of patients can be effectively improved after surgery. Radiotherapy can reduce the risk of local recurrences, whereas RAI therapy has a limited effect on local and extraspinal tumor control. Neurological status was independently associated with the patients' survival.
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Affiliation(s)
- Xiajun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Department of Spinal Surgery, Baoji Municipal Central Hospital, Baoji, China
| | - Panpan Hu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Shuheng Zhai
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ben Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Hua Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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12
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Coca-Pelaz A, Rodrigo JP, Shah JP, Nixon IJ, Hartl DM, Robbins KT, Kowalski LP, Mäkitie AA, Hamoir M, López F, Saba NF, Nuyts S, Rinaldo A, Ferlito A. Recurrent Differentiated Thyroid Cancer: The Current Treatment Options. Cancers (Basel) 2023; 15:2692. [PMID: 37345029 PMCID: PMC10216352 DOI: 10.3390/cancers15102692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
Differentiated thyroid carcinomas (DTC) have an excellent prognosis, but this is sometimes overshadowed by tumor recurrences following initial treatment (approximately 15% of cases during follow-up), due to unrecognized disease extent at initial diagnosis or a more aggressive tumor biology, which are the usual risk factors. The possible sites of recurrence are local, regional, or distant. Local and regional recurrences can usually be successfully managed with surgery and radioiodine therapy, as are some isolated distant recurrences, such as bone metastases. If these treatments are not possible, other therapeutic options such as external beam radiation therapy or systemic treatments should be considered. Major advances in systemic treatments have led to improved progression-free survival in patients previously considered for palliative treatments; among these treatments, the most promising results have been achieved with tyrosine kinase inhibitors (TKI). This review attempts to give a comprehensive overview of the current treatment options suited for recurrences and the new treatments that are available in cases where salvage surgery is not possible or in cases resistant to radioiodine.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Jatin P. Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Iain J. Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh EH3 9YL, UK;
| | - Dana M. Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, CEDEX, 94805 Villejuif, France;
- Laboratoire de Phonétique et de Phonologie, 75005 Paris, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Luiz P. Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, São Paulo 01509-001, Brazil;
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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13
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Kato S, Demura S, Yokogawa N, Shimizu T, Kobayashi M, Yamada Y, Murakami H, Tsuchiya H. Metastasectomy of spinal lesions from thyroid carcinomas. Bone Joint J 2023; 105-B:575-582. [PMID: 37121585 DOI: 10.1302/0301-620x.105b5.bjj-2022-1003.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Patients with differentiated thyroid carcinomas (DTCs) have a favourable long-term survival. Spinal metastases (SMs) cause a decline in performance status (PS), directly affecting mortality and indirectly preventing the use of systemic therapies. Metastasectomy is indicated, if feasible, as it yields the best local tumour control. Our study aimed to examine the long-term clinical outcomes of metastasectomy for SMs of thyroid carcinomas. We collected data on 22 patients with DTC (16 follicular and six papillary carcinomas) and one patient with medullary carcinoma who underwent complete surgical resection of SMs at our institution between July 1992 and July 2017, with a minimum postoperative follow-up of five years. The cancer-specific survival (CSS) from the first spinal metastasectomy to death or the last follow-up was determined using Kaplan-Meier analysis. Potential factors associated with survival were evaluated using the log-rank test. We analyzed the clinical parameters and outcome data, including pre- and postoperative disability (Eastern Cooperative Oncology Group PS 3), lung and non-spinal bone metastases, and history of radioiodine and kinase inhibitor therapies. Lung and other bone metastases at the time of surgery were observed in ten and eight patients, respectively. Three patients experienced local tumour recurrences at the operated site. The five- and ten-year CSS rates in the 22 patients with DTC were 77% and 52%, respectively. Pre- and postoperative disability and operative site tumour recurrence were identified as risk factors for short postoperative survival. Metastasectomy for resectable SM from DTC yielded favourable results and has the potential to improve survival.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yohei Yamada
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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14
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Wirth LJ, Durante C, Topliss DJ, Winquist E, Robenshtok E, Iwasaki H, Luster M, Elisei R, Leboulleux S, Tahara M. Lenvatinib for the treatment of radioiodine-refractory differentiated thyroid cancer: treatment optimization for maximum clinical benefit. HEAD AND NECK TUMORS (HNT) 2023. [DOI: 10.17650/2222-1468-2022-12-4-81-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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15
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Prognosis of thyroid carcinoma patients with osseous metastases: an SEER-based study with machine learning. Ann Nucl Med 2023; 37:289-299. [PMID: 36867400 DOI: 10.1007/s12149-023-01826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Osseous metastasis (OM) is the second most common site of thyroid cancer distant metastasis and presents a poor prognosis. Accurate prognostic estimation for OM has clinical significance. Ascertain the risk factors for survival and develop an effective model to predict the 3-year, 5-year overall survival (OS) and cancer-specific survival (CSS) for thyroid cancer patients with OM. METHODS We retrieved the information of patients with OMs between 2010 and 2016 from the Surveillance, Epidemiology, and End Result Program. The Chi-square test, and univariate and multivariate Cox regression analyses were performed. Four machine learning (ML) algorithms, which were most commonly used in this field, were applied. RESULT A total of 579 patients having OMs were eligible. Advanced age, tumor size ≥ 40 mm, combined with other distant metastasis were associated with worse OS in DTC OMs patients. Radioactive iodine (RAI) significantly improved CSS in both males and females. Among four ML models [logistic regression, support vector machines, extreme gradient boosting, and random forest (RF)], RF had the best performance [area under the receiver-operating characteristic curve: 0.9378 for 3-year CSS, 0.9105 for 5-year CSS, 0.8787 for 3-year OS, 0.8909 for 5-year OS]. The accuracy and specificity of RF were also the best. CONCLUSIONS RF model shall be used to establish an accurate prognostic model for thyroid cancer patients with OM, not only from the SEER cohort but also intended for all thyroid cancer patients in the general population, which may be applicable in clinical practice in the future.
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16
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Loharkar S, Basu S. Tenosynovial Giant Cell Tumor of Foot in a Patient with Radioiodine-Refractory Thyroid Cancer: Imaging Findings on FDG-PET/CT, MRI, and Radioiodine Scan. World J Nucl Med 2023; 22:63-66. [PMID: 36923979 PMCID: PMC10010861 DOI: 10.1055/s-0042-1758804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We herein illustrate a case of benign tenosynovial giant cell tumor, which was incidentally detected as FDG-avid lesion on PET/CT in a patient with radioiodine refractory thyroid cancer, with predominantly non-iodine concentrating disease. The lesion was followed up clinically and with local MRI annually for subsequent 3 years. The utility of hybrid PET-CT imaging, the non-iodine concentration of the tumor along with clinical knowledge, and findings on other imaging and pathological modalities in answering and diagnosing incidental benign musculoskeletal tumors in a patient with known thyroid malignancy are presented here.
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Affiliation(s)
- Sarvesh Loharkar
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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17
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Gugnoni M, Lorenzini E, Faria do Valle I, Remondini D, Castellani G, Torricelli F, Sauta E, Donati B, Ragazzi M, Ghini F, Piana S, Ciarrocchi A, Manzotti G. Adding pieces to the puzzle of differentiated-to-anaplastic thyroid cancer evolution: the oncogene E2F7. Cell Death Dis 2023; 14:99. [PMID: 36765037 PMCID: PMC9918458 DOI: 10.1038/s41419-023-05603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
Anaplastic Thyroid Cancer (ATC) is the most aggressive and de-differentiated subtype of thyroid cancer. Many studies hypothesized that ATC derives from Differentiated Thyroid Carcinoma (DTC) through a de-differentiation process triggered by specific molecular events still largely unknown. E2F7 is an atypical member of the E2F family. Known as cell cycle inhibitor and keeper of genomic stability, in specific contexts its function is oncogenic, guiding cancer progression. We performed a meta-analysis on 279 gene expression profiles, from 8 Gene Expression Omnibus patient samples datasets, to explore the causal relationship between DTC and ATC. We defined 3 specific gene signatures describing the evolution from normal thyroid tissue to DTC and ATC and validated them in a cohort of human surgically resected ATCs collected in our Institution. We identified E2F7 as a key player in the DTC-ATC transition and showed in vitro that its down-regulation reduced ATC cells' aggressiveness features. RNA-seq and ChIP-seq profiling allowed the identification of the E2F7 specific gene program, which is mainly related to cell cycle progression and DNA repair ability. Overall, this study identified a signature describing DTC de-differentiation toward ATC subtype and unveiled an E2F7-dependent transcriptional program supporting this process.
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Affiliation(s)
- Mila Gugnoni
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eugenia Lorenzini
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Daniel Remondini
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Gastone Castellani
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Sauta
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Benedetta Donati
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Moira Ragazzi
- Pathology Unit, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Ghini
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Gloria Manzotti
- Laboratory of Translational Research, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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Jiang Q, Zhai M, Lin X, Ren C, Li Y, Ye F, Gong Y, Liu S. Case Report: A papillary thyroid microcarcinoma patient with skip lymph node metastasis and multiple distant metastasis. Front Surg 2023; 9:1019846. [PMID: 36743898 PMCID: PMC9889854 DOI: 10.3389/fsurg.2022.1019846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is defined as PTC with a diameter less than 1 centimeter. Most lymph nodes of PTC patients have metastasized to the central neck, and a few lymph nodes have metastasized to the lateral neck. Skip lymph node metastasis, that is, lateral cervical lymph node metastasis without central lymph node metastasis, is even less common. Additionally, distant metastasis of PTMC is also rare, mainly occurring in the lung and bone. Here, we reported a case of PTMC patient with skip lymph node metastasis and multiple distant metastasis. The patient presented with a huge shoulder mass and the primary tumor was found to originate from the thyroid. However, the patient only suffered with PTMC via postoperative pathological results, and interestingly, the patient only had skip lymph node metastasis. Thus, we should focus on PTMC patients with lateral cervical lymph nodes metastasis, especially those with skip metastasis. In addition, this case provides a new perspective for us to understand of skip lymph metastasis and distant metastasis of PTMC.
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Affiliation(s)
- Qin Jiang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mimi Zhai
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xiang Lin
- Department of General Surgery, Huaihua Second People’s Hospital, Huaihua, China
| | - Chutong Ren
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunxia Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Fei Ye
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Gong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sushun Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Correspondence: Sushun Liu ;
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Colombo E, Ottini A, Licitra L. Oligometastatic disease from differentiated thyroid cancer: best treatment schemes. Curr Opin Oncol 2023; 35:15-21. [PMID: 36475458 PMCID: PMC9794151 DOI: 10.1097/cco.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Patients with slowly progressive and/or symptomatic oligometastatic radioactive iodine refractory (RAIR) differentiated thyroid carcinomas (DTCs) are candidates to receive locoregional treatment to delay the start of systemic therapy with multikinase inhibitors. Information provided by the recent literature has not been extensively reviewed in previous published works, thus we aim to bridge this gap. RECENT FINDINGS We present for each metastatic site the different locoregional treatment options, contraindications and potential adverse events. Some techniques can be combined together, whereas others are discouraged in certain situations, requiring a high level of expertise and multidisciplinarity in the treatment algorithm. SUMMARY Different techniques of radiation therapy and interventional radiology allow to control the metastatic spread. However, as no clinical trials are available to compare the treatment schemes in terms of safety and potential impact on the prognosis, the most appropriate option for each patient should be selected within a multidisciplinary decision making, taking into account the clinical conditions and the pattern/rapidity of metastatic disease.
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Affiliation(s)
- Elena Colombo
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Arianna Ottini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
- Department of Oncology and Hematology, University of Milan, Milan, Italy
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Mao Y, Lan H, Lin W, Liang J, Huang H, Li L, Wen J, Chen G. Machine learning algorithms are comparable to conventional regression models in predicting distant metastasis of follicular thyroid carcinoma. Clin Endocrinol (Oxf) 2023; 98:98-109. [PMID: 35171531 DOI: 10.1111/cen.14693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Distant metastasis often indicates a poor prognosis, so early screening and diagnosis play a significant role. Our study aims to construct and verify a predictive model based on machine learning (ML) algorithms that can estimate the risk of distant metastasis of newly diagnosed follicular thyroid carcinoma (FTC). DESIGN This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. PATIENTS A total of 5809 FTC patients were included in the data analysis. Among them, there were 214 (3.68%) cases with distant metastasis. METHOD Univariate and multivariate logistic regression (LR) analyses were used to determine independent risk factors. Seven commonly used ML algorithms were applied for predictive model construction. We used the area under the receiver-operating characteristic (AUROC) curve to select the best ML algorithm. The optimal model was trained through 10-fold cross-validation and visualized by SHapley Additive exPlanations (SHAP). Finally, we compared it with the traditional LR method. RESULTS In terms of predicting distant metastasis, the AUROCs of the seven ML algorithms were 0.746-0.836 in the test set. Among them, the Extreme Gradient Boosting (XGBoost) had the best prediction performance, with an AUROC of 0.836 (95% confidence interval [CI]: 0.775-0.897). After 10-fold cross-validation, its predictive power could reach the best [AUROC: 0.855 (95% CI: 0.803-0.906)], which was slightly higher than the classic binary LR model [AUROC: 0.845 (95% CI: 0.818-0.873)]. CONCLUSIONS The XGBoost approach was comparable to the conventional LR method for predicting the risk of distant metastasis for FTC.
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Affiliation(s)
- Yaqian Mao
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Huiyu Lan
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jixing Liang
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Huibin Huang
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Liantao Li
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Junping Wen
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Gang Chen
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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Pidchenko NS, Astapieva OM, Vasyliev LY, Grushka GV, Paskevych OI, Pushkar OS, Pidlisnyi RA, Fedulenkova YY, Myroshnychenko MS. AGGRESSIVE COURSE OF DIFFERENTIATED THYROID GLAND CANCER IN A PATIENT WITH INSULIN RESISTANCE: CASE ANALYSIS FROM PRACTICE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2878-2883. [PMID: 36591784 DOI: 10.36740/wlek202211227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Differentiated thyroid cancer (DTC) is usually characterized by a harmless clinical behavior but in some cases it can manifest itself as a metastatic damage to the bone system. The authors reported case from their practice of an aggressive DTC course in a patient with insulin resistance, accompanied by the development of metastases in the bone system. The main goals of the patient's treatment at each stage of radioiodine therapy were to reduce the foci of metastatic bone damage in terms of their number and volume as well as insulin resistance as a risk factor affecting insulin-like growth factors. A clinical case analysis found that radioiodine therapy might be useful for disease control in cases with potentially aggressive variants of DTC. This category of patients requires careful monitoring of insulin resistance, insulin-like growth factors and appropriate antitumor treatment.
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Affiliation(s)
- Nataliia S Pidchenko
- STATE ORGANIZATION «GRYGORIEV INSTITUTE FOR MEDICAL RADIOLOGY AND ONCOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZIV, KHARKIV, UKRAINE
| | - Olha M Astapieva
- STATE ORGANIZATION «GRYGORIEV INSTITUTE FOR MEDICAL RADIOLOGY AND ONCOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Leonid Ya Vasyliev
- STATE ORGANIZATION «GRYGORIEV INSTITUTE FOR MEDICAL RADIOLOGY AND ONCOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | | | | | - Olena S Pushkar
- STATE ORGANIZATION «GRYGORIEV INSTITUTE FOR MEDICAL RADIOLOGY AND ONCOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE, KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZIV, KHARKIV, UKRAINE
| | - Ruslan A Pidlisnyi
- STATE ORGANIZATION «GRYGORIEV INSTITUTE FOR MEDICAL RADIOLOGY AND ONCOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE, KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZIV, KHARKIV, UKRAINE
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Nervo A, Retta F, Ragni A, Piovesan A, Gallo M, Arvat E. Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective. Cancer Manag Res 2022; 14:3047-3062. [PMID: 36275786 PMCID: PMC9584766 DOI: 10.2147/cmar.s340967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with thyroid cancer (TC) usually have an excellent prognosis; however, 5-10% of them develop an advanced disease. The prognosis of this subgroup is still favourable if the lesions respond to radioactive iodine (RAI) treatment. Nearly two-thirds of advanced TC patients become RAI-refractory (RAI-R), and their management is challenging. A multidisciplinary approach in the context of a tumour board is essential to define a personalized strategy. Systemic therapy is not always the best option. In case of slow neoplastic growth and low tumour burden, active surveillance may represent a valuable choice. Local approaches might be considered if the disease progression is limited to a single or few lesions, also in combination and during systemic therapy. Antiresorptive treatment may be started in presence of bone metastases. In case of rapid and/or symptomatic progression involving multiple lesions and/or organs, systemic therapy has to be considered, in absence of contraindications. The multi-kinase inhibitors (MKIs) lenvatinib and sorafenib are currently available as first-line treatment for advanced progressive RAI-R TC. Among second-line options, cabozantinib has been recently approved in RAI-R TC who progressed during MKIs targeting the vascular endothelial growth factor receptor (VEGFR). In the last few years, next-generation sequencing (NGS) assays have been increasingly employed, permitting identification of the genetic alterations harboured by TC, with a significant impact on patients' management. Novel selective targeted therapies have been introduced for the treatment of RAI-R TC in selected cases: REarranged during Transfection (RET) inhibitors (selpercatinib and pralsetinib) and Tropomyosin Receptor Kinase (TRK) inhibitors (larotrectinib and entrectinib) have recently expanded the panorama of the therapeutic options. Moreover, immune checkpoint inhibitors (ICIs) have shown promising results, and they are still under investigation.
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Affiliation(s)
- Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy,Correspondence: Alice Nervo, Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Via Genova 3, Turin, 10126, Italy, Tel +390116336611, Fax +390116334703, Email
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
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Chen YK, Chen YC, Lin WX, Zheng JH, Liu YY, Zou J, Cai JH, Ji ZQ, Chen LZ, Li ZY, Chen YX. Follicular carcinoma of the thyroid with a single metastatic lesion in the lumbar spine: A case report. World J Clin Cases 2022; 10:9493-9501. [PMID: 36159419 PMCID: PMC9477679 DOI: 10.12998/wjcc.v10.i26.9493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The bone is the second most common site of thyroid cancer metastasis, after the lung. Treatment options for bone metastasis of thyroid cancer include surgery, radioiodine therapy (RAIT), external radiation therapy, thyroid-stimulating hormone (TSH) inhibition, bisphosphonates, and small-molecule targeted therapies. In most cases, thyroid carcinoma is found in the thyroid tissue; reports of follicular thyroid carcinoma with a single metastasis to the lumbar spine are rare.
CASE SUMMARY We report a case of bone metastasis as the only clinical manifestation of thyroid cancer. The patient was a 67-year-old woman with lumbar pain for 7 years and aggravation with intermittent claudication who had previously undergone partial thyroidectomy of a benign thyroid lesion. No abnormal nodules were found in the bilateral thyroid glands. However, imaging studies were consistent with a spinal tumor, and the lesion was diagnosed as a metastatic follicular carcinoma of thyroid origin. We adopted a multidisciplinary collaboration and comprehensive treatment approach. The patient underwent lumbar spine surgery, total resection of the thyroid, postoperative TSH suppression therapy, and RAIT. There were no complications associated with the operation, and the patient had good postoperative recovery. She has experienced no recurrence.
CONCLUSION Follicular thyroid carcinoma is associated with early hematogenous metastasis, and the bone is a typical site of metastasis. Single bone metastasis is not a contraindication to medical procedures, and providing the appropriate therapy can result in better outcomes and quality of life for these patients.
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Affiliation(s)
- Yao-Kun Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yu-Chun Chen
- Department of Bone, Joint and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Wei-Xun Lin
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Jie-Hua Zheng
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yi-Yuan Liu
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Juan Zou
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Jie-Hui Cai
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ze-Qi Ji
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ling-Zhi Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Zhi-Yang Li
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ye-Xi Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
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Zhang R, Zhang W, Wu C, Jia Q, Chai J, Meng Z, Zheng W, Tan J. Bone metastases in newly diagnosed patients with thyroid cancer: A large population-based cohort study. Front Oncol 2022; 12:955629. [PMID: 36033484 PMCID: PMC9416865 DOI: 10.3389/fonc.2022.955629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Population-based estimates of the incidence and prognosis of bone metastases (BM) stratified by histologic subtype at diagnosis of thyroid cancer are limited. Methods Using multivariable logistic and Cox regression analyses, we identified risk factors for BM and investigated the prognostic survival of BM patients between 2010 and 2015 via the Surveillance, Epidemiology, and End Results (SEER) database. Results Among 64,083 eligible patients, a total of 347 patients with BM at the time of diagnosis were identified, representing 0.5% of the entire cohort but 32.4% of the subset with metastases. BM incidence was highest (11.6%) in anaplastic thyroid cancer (ATC), which, nevertheless, was highest (61.5%) in follicular thyroid cancer (FTC) among the subset with metastases. The median overall survival among BM patients was 40.0 months, and 1-, 3-, and 5-year survival rates were 65.2%, 51.3%, and 38.7%, respectively. Compared with papillary thyroid cancer (PTC), FTC (aOR, 6.33; 95% CI, 4.72–8.48), medullary thyroid cancer (MTC) (aOR, 6.04, 95% CI, 4.09–8.92), and ATC (aOR, 6.21; 95% CI, 4.20–9.18) significantly increased the risk of developing BM. However, only ATC (aHR, 6.07; 95% CI, 3.83–9.60) was independently associated with worse survival in multivariable analysis. Additionally, patients with BM alone (56.5%) displayed the longest median survival (66.0 months), compared with those complicated with one extraskeletal metastatic site (lung, brain, or liver) (35.2%; 14.0 months) and two or three sites (8.3%; 6.0 months). The former 5-year overall survival rate was 52.6%, which, however, drastically declined to 23.0% in patients with one extraskeletal metastatic site and 9.1% with two or three sites. Conclusion Closer bone surveillance should be required for patients with FTC, MTC, and ATC, and extraskeletal metastases at initial diagnosis frequently predict a poorer prognosis.
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Affiliation(s)
- Ruiguo Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Ruiguo Zhang, ; Jian Tan,
| | - Wenxin Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Cailan Wu
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, Tianjin, China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinyan Chai
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Ruiguo Zhang, ; Jian Tan,
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Pierre-Alexis A, SCHNEEGANS O, KOCH G, WEISS J, CAUDRELIER J, DALILI D, PEROLAT R, AULOGE P, Luigi CAZZATO R, GANGI A, GARNON J. Technique efficacy and safety following percutaneous cryoablation of extra-spinal thyroid cancer bone metastases with curative intent: single-center experience with a median follow-up of more than 5 years. J Vasc Interv Radiol 2022; 33:797-804. [DOI: 10.1016/j.jvir.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
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Sethakorn N, Heninger E, Sánchez-de-Diego C, Ding AB, Yada RC, Kerr SC, Kosoff D, Beebe DJ, Lang JM. Advancing Treatment of Bone Metastases through Novel Translational Approaches Targeting the Bone Microenvironment. Cancers (Basel) 2022; 14:757. [PMID: 35159026 PMCID: PMC8833657 DOI: 10.3390/cancers14030757] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Bone metastases represent a lethal condition that frequently occurs in solid tumors such as prostate, breast, lung, and renal cell carcinomas, and increase the risk of skeletal-related events (SREs) including pain, pathologic fractures, and spinal cord compression. This unique metastatic niche consists of a multicellular complex that cancer cells co-opt to engender bone remodeling, immune suppression, and stromal-mediated therapeutic resistance. This review comprehensively discusses clinical challenges of bone metastases, novel preclinical models of the bone and bone marrow microenviroment, and crucial signaling pathways active in bone homeostasis and metastatic niche. These studies establish the context to summarize the current state of investigational agents targeting BM, and approaches to improve BM-targeting therapies. Finally, we discuss opportunities to advance research in bone and bone marrow microenvironments by increasing complexity of humanized preclinical models and fostering interdisciplinary collaborations to translational research in this challenging metastatic niche.
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Affiliation(s)
- Nan Sethakorn
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Erika Heninger
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
| | - Cristina Sánchez-de-Diego
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Adeline B. Ding
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
| | - Ravi Chandra Yada
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Sheena C. Kerr
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - David Kosoff
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - David J. Beebe
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Joshua M. Lang
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
- Wisconsin Institutes for Medical Research, 1111 Highland Ave., Madison, WI 53705, USA
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Wirth LJ, Durante C, Topliss DJ, Winquist E, Robenshtok E, Iwasaki H, Luster M, Elisei R, Leboulleux S, Tahara M. OUP accepted manuscript. Oncologist 2022; 27:565-572. [PMID: 35482606 PMCID: PMC9256022 DOI: 10.1093/oncolo/oyac065] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Lenvatinib is a multitargeted tyrosine kinase inhibitor approved for treating patients with locally recurrent or metastatic progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC). In this review, we discuss recent developments in the optimization of RR-DTC treatment with lenvatinib. Summary Initiation of lenvatinib treatment before a worsening of Eastern Cooperative Oncology Group performance status and elevated neutrophil-to-lymphocyte ratio could benefit patients with progressive RR-DTC. The median duration of response with lenvatinib was inversely correlated with a smaller tumor burden, and prognosis was significantly worse in patients with a high tumor burden. An 18 mg/day starting dose of lenvatinib was not noninferior to 24 mg/day and had a comparable safety profile. Timely management of adverse events is crucial, as patients with shorter dose interruptions benefitted more from lenvatinib treatment. Caution should be exercised when initiating lenvatinib in patients who have tumor infiltration into the trachea or other organs, or certain histological subtypes of DTC, as these are risk factors for fistula formation or organ perforation. The Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid (SELECT) eligibility criteria should be considered prior to initiating lenvatinib treatment. Conclusions Current evidence indicates that patients benefit most from lenvatinib treatment that is initiated earlier in advanced disease when the disease burden is low. A starting dose of lenvatinib 24 mg/day, with dose modifications as required, yields better outcomes as compared to 18 mg/day. Appropriate supportive care, including timely identification of adverse events, is essential to manage toxicities associated with lenvatinib, avoid longer dose interruptions, and maximize efficacy.
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Affiliation(s)
- Lori J Wirth
- Corresponding author: Lori J. Wirth, MD, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 01944, USA. Tel: +1 617 724 4000;
| | | | | | | | - Eyal Robenshtok
- Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | | | - Sophie Leboulleux
- Gustave-Roussy, Villejuif, France, and the University of Paris-Saclay, Gif-sur-Yvette, France
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
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Moon JB, Yoo SW, Lee C, Kim DY, Pyo A, Kwon SY. Multimodal Imaging-Based Potential Visualization of the Tumor Microenvironment in Bone Metastasis. Cells 2021; 10:cells10112877. [PMID: 34831100 PMCID: PMC8616082 DOI: 10.3390/cells10112877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Bone metastasis (BM) is the most common malignant bone tumor and a significant cause of morbidity and mortality for patients with cancer. Compared to other metastatic organs, bone has unique characteristics in terms of the tumor microenvironment (TME). Precise assessments of the TME in BM could be an important step for developing an optimized management plan for patient care. Imaging approaches for BM have several advantages, such as biopsy not being required, multiple site evaluation, and serial assessment in the same sites. Owing to the developments of new imaging tracers or imaging modalities, bone TME could be visualized using multimodal imaging techniques. In this review, we describe the BM pathophysiology, diagnostic principles of major imaging modalities, and clinically available imaging modalities to visualize the TME in BM. We also discuss how the interactions between various factors affecting the TME could be visualized using multimodal imaging techniques.
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Affiliation(s)
- Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Dong-Yeon Kim
- College of Pharmacy and Research Institute of Pharmaceutical Science, Gyeongsang National University, Jinju 52828, Korea;
| | - Ayoung Pyo
- Accelerator & RI Development Team, Korea Atomic Energy Research Institute, Daejeon 56212, Korea;
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
- Correspondence: ; Tel.: +82-61-379-7273
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Kato S, Demura S, Shinmura K, Yokogawa N, Shimizu T, Tsuchiya H. Current Management of Bone Metastases from Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13174429. [PMID: 34503240 PMCID: PMC8431580 DOI: 10.3390/cancers13174429] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC) can live longer than those with BMs from other cancers. BMs from DTC create destructive lesions and easily cause intractable pain and neurological symptoms, including paralysis. These symptoms related to BMs affect mortality directly and indirectly by hampering the application of systemic therapies. Therefore, long-term local control of BMs in patients with DTC is desired, especially in patients with single or a small number of metastases. Local treatments for BMs have recently become advanced and sophisticated in surgery, radiotherapy, and percutaneous procedures. These therapies, either alone or in combination with other treatments, can effectively improve, or prevent the deterioration of, the performance status and quality of life of patients with DTC-BM. Among local therapies, complete surgical resection and stereotactic radiosurgery are the mainstay for achieving long-term control of DTC-BM. Abstract After the lung, the skeleton is the second most common site of distant metastases in differentiated thyroid carcinoma (DTC). Patients with osteolytic bone metastases (BMs) from thyroid carcinoma often have significantly reduced performance status and quality of life. Recent advancements in cancer therapy have improved overall survival in multiple cancer subtypes, including thyroid cancer. Therefore, long-term local control of thyroid BMs is desired, especially in patients with a single metastasis or oligometastases. Here, we reviewed the current management options for DTC-BMs and especially focused on local treatments for long-term local tumor control from an orthopedic tumor surgeon’s point of view. Metastasectomy and stereotactic radiosurgery can be performed either alone or in combination with radioiodine therapy and kinase inhibitors to cure skeletal lesions in selected patients. Percutaneous procedures have been developed in recent years, and they can also have a curative role in small BMs. Recent advancements in local therapies have the potential to provide not only long-term local tumor control but also a better prognosis.
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