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Cazzato RL, Dalili D, De Marini P, Koch G, Autrusseau PA, Weiss J, Auloge P, Garnon J, Gangi A. Bone Consolidation: A Practical Guide for the Interventional Radiologist. Cardiovasc Intervent Radiol 2023; 46:1458-1468. [PMID: 36539512 DOI: 10.1007/s00270-022-03340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- Department of Human Anatomy, University Hospital of Strasbourg, Strasbourg, France
| | | | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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Umakoshi N, Matsui Y, Tomita K, Uka M, Kawabata T, Iguchi T, Hiraki T. Image-Guided Ablation Therapies for Extrahepatic Metastases from Hepatocellular Carcinoma: A Review. Cancers (Basel) 2023; 15:3665. [PMID: 37509326 PMCID: PMC10378118 DOI: 10.3390/cancers15143665] [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: 06/13/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The most common sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, intra-abdominal lymph nodes, bones, and adrenal glands, in that order. Although systemic therapies are a common treatment for patients with extrahepatic metastases, local ablative therapies for the extrahepatic metastatic lesions can be performed in selected patients. In this article, the literature on image-guided thermal ablation for metastasis to each organ was reviewed to summarize the current evidence. Radiofrequency ablation was the most commonly evaluated technique, and microwave ablation, cryoablation, and percutaneous ethanol injection were also utilized. The local control rate of thermal ablation therapy was relatively favorable, at approximately 70-90% in various organs. The survival outcomes varied among the studies, and several studies reported that the absence of viable intrahepatic lesions was associated with improved survival rates. Since only retrospective data from relatively small studies has been available thus far, more robust studies with prospective designs and larger cohorts are desired to prove the usefulness of thermal ablation for extrahepatic metastases from HCC.
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Affiliation(s)
- Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Okayama University Graduate School of Health Science, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
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Leboulleux S, Lamartina L, Hadoux J, Baudin E, Schlumberger M. Emerging drugs for the treatment of radioactive iodine refractory papillary thyroid cancer. Expert Opin Investig Drugs 2022; 31:669-679. [PMID: 35522027 DOI: 10.1080/13543784.2022.2071696] [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: 11/04/2022]
Abstract
INTRODUCTION The most frequent radioactive (RAI) refractory thyroid cancers are papillary thyroid carcinoma, followed by poorly differentiated thyroid carcinoma. They are rare and lethal. In recent years, significant therapeutic progress has been achieved. AREAS COVERED This paper offers insights on refractoriness to RAI treatment and the optimization of treatment initiation and treatment choice. Clinical trials performed with anti-angiogenic kinase inhibitors and with targeted inhibitors in patients with BRAF, RAS mutation or RET, TRK or ALK fusion are discussed. EXPERT OPINION These treatments provide high response rates. Anti-angiogenic kinase inhibitors improve median progression-free-survival; however, their benefit in terms of overall survival has been shown in only few subsets of patients. Treatment sequencing is challenging; in the absence of targetable abnormality, lenvatinib should be used as first line treatment. Options for second line treatment include lenvatinib (if not given at first line), cabozantinib or the addition of an anti-checkpoint antibody. In patients with a targetable abnormality, specific inhibitors, might be used as first line treatment and lenvatinib as second line or vice-versa. Further studies are needed, based on documented genomic and immunologic characteristics of the tumor to assess the potential role of combination and redifferentiation therapy.
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Affiliation(s)
- Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 rue Edouard Vaillant 94800 Villejuif, France.,Division of Endocrinology, Diabetes, Nutrition and Therapeutic patient education, Geneva University Hospitals, Geneva, Switzerland
| | - Livia Lamartina
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 rue Edouard Vaillant 94800 Villejuif, France
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CIRSE Standards of Practice on Thermal Ablation of Bone Tumours. Cardiovasc Intervent Radiol 2022; 45:591-605. [PMID: 35348870 PMCID: PMC9018647 DOI: 10.1007/s00270-022-03126-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/28/2022] [Indexed: 02/03/2023]
Abstract
Background Percutaneous thermal ablation is an effective, minimally invasive means of treating a variety of focal benign and malignant osseous lesions. To determine the role of ablation in individual cases, multidisciplinary team (MDT) discussion is required to assess the suitability and feasibility of a thermal ablative approach, to select the most appropriate technique and to set the goals of treatment i.e. curative or palliative. Purpose This document will presume the indication for treatment is clear and approved by the MDT and will define the standards required for the performance of each modality. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of thermal ablation of bone tumours. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in thermal ablation of bone tumours. The writing group reviewed the existing literature on thermal ablation of bone tumours, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects from 2009 to 2019. Selected studies published in 2020 and 2021 during the course of writing these standards were subsequently included. The final recommendations were formulated through consensus. Results Recommendations were produced for the performance of thermal ablation of bone tumours taking into account the biologic behaviour of the tumour and the therapeutic intent of the procedure. Recommendations are provided based on lesion characteristics and thermal modality, for the use of tissue monitoring and protection, and for the appropriately timed application of adjunctive procedures such as osseus consolidation and transarterial embolisation. Results Percutaneous thermal ablation has an established role in the successful management of bone lesions, with both curative and palliative intent. This Standards of Practice document provides up-to-date recommendations for the safe performance of thermal ablation of bone tumours.
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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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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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Gravel G, Roussel A, Mellot F. Anterior epidural carbon dioxide dissection during spine cryoablation. Jpn J Radiol 2021; 40:103-105. [PMID: 34279798 DOI: 10.1007/s11604-021-01171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Spine cryoablation (SC) of posterior vertebral lesions exposes to neuronal damages and incomplete treatment due to the proximity of the spinal canal. Carbon dioxide (CO2) dissection is a nerve protective method that can be used during spine cryoablation that tends to distribute in non-dependent areas. The purpose of this technical note was to expose the feasibility of anterior epidural CO2 dissection during SC in prone decubitus. MATERIALS AND METHODS Three consecutives patients underwent SC of metastases abutting the posterior wall of the vertebra with anterior epidural CO2 dissection. A post-ablation MRI was performed after each cryoablation to state if the treatment was complete or incomplete. Complications were reported using the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). RESULTS Peri-procedural anterior epidural injection of CO2 was successful in all 3 procedures. Treatment was considered complete on all post-ablation MRI with ablation margins encompassing the targeted metastasis. No complication according to the CTCAE was reported. CONCLUSION CO2 dissection of the anterior epidural space was successful in all 3 procedures allowing complete treatment on all post-ablation MRI.
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Affiliation(s)
- Guillaume Gravel
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
| | - Alexandre Roussel
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
| | - François Mellot
- Department of Diagnostic and Interventional Radiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
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Mauri G, Hegedüs L, Bandula S, Cazzato RL, Czarniecka A, Dudeck O, Fugazzola L, Netea-Maier R, Russ G, Wallin G, Papini E. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J 2021; 10:185-197. [PMID: 34178704 PMCID: PMC8215982 DOI: 10.1159/000516469] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
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Affiliation(s)
- Giovanni Mauri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- *Laszlo Hegedüs,
| | - Steven Bandula
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Oliver Dudeck
- Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gilles Russ
- Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Göran Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Enrico Papini
- Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy
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Nervo A, Ragni A, Retta F, Gallo M, Piovesan A, Liberini V, Gatti M, Ricardi U, Deandreis D, Arvat E. Bone metastases from differentiated thyroid carcinoma: current knowledge and open issues. J Endocrinol Invest 2021; 44:403-419. [PMID: 32743746 PMCID: PMC7878269 DOI: 10.1007/s40618-020-01374-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
Bone represents the second most common site of distant metastases in differentiated thyroid cancer (DTC). The clinical course of DTC patients with bone metastases (BM) is quite heterogeneous, but generally associated with low survival rates. Skeletal-related events might be a serious complication of BM, resulting in high morbidity and impaired quality of life. To achieve disease control and symptoms relief, multimodal treatment is generally required: radioiodine therapy, local procedures-including surgery, radiotherapy and percutaneous techniques-and systemic therapies, such as kinase inhibitors and antiresorptive drugs. The management of DTC with BM is challenging: a careful evaluation and a personalized approach are essential to improve patients' outcomes. To date, prospective studies focusing on the main clinical aspects of DTC with BM are scarce; available analyses mainly include cohorts assembled over multiple decades, small samples sizes and data about BM not always separated from those regarding other distant metastases. The aim of this review is to summarize the most recent evidences and the unsolved questions regarding BM in DTC, analyzing several key issues: pathophysiology, prognostic factors, role of anatomic and functional imaging, and clinical management.
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Affiliation(s)
- A. Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A. Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - F. Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M. Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A. Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - V. Liberini
- Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M. Gatti
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - U. Ricardi
- Radiation Oncology, Department of Oncology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - D. Deandreis
- Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - E. Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Schlumberger M, Leboulleux S. Current practice in patients with differentiated thyroid cancer. Nat Rev Endocrinol 2021; 17:176-188. [PMID: 33339988 DOI: 10.1038/s41574-020-00448-z] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 01/30/2023]
Abstract
Considerable changes have occurred in the management of differentiated thyroid cancer (DTC) during the past four decades, based on improved knowledge of the biology of DTC and on advances in therapy, including surgery, the use of radioactive iodine (radioiodine), thyroid hormone treatment and availability of recombinant human TSH. Improved diagnostic tools are available, including determining serum levels of thyroglobulin, neck ultrasonography, imaging (CT, MRI, SPECT-CT and PET-CT), and prognostic classifications have been improved. Patients with low-risk DTC, in whom the risk of thyroid cancer death is <1% and most recurrences can be cured, currently represent the majority of patients. By contrast, patients with high-risk DTC represent 5-10% of all patients. Most thyroid cancer-related deaths occur in this group of patients and recurrences are frequent. Patients with high-risk DTC require more aggressive treatment and follow-up than patients with low-risk DTC. Finally, the strategy for treating patients with intermediate-risk DTC is frequently defined on a case-by-case basis. Prospective trials are needed in well-selected patients with DTC to demonstrate the extent to which treatment and follow-up can be limited without increasing the risk of recurrence and thyroid cancer-related death.
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Affiliation(s)
- Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and Université Paris Saclay, Villejuif, France.
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy and Université Paris Saclay, Villejuif, France
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RADTHYR: an open-label, single-arm, prospective multicenter phase II trial of Radium-223 for the treatment of bone metastases from radioactive iodine refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2021; 48:3238-3249. [PMID: 33619600 PMCID: PMC8426251 DOI: 10.1007/s00259-021-05229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
Purpose This is the first prospective trial evaluating the efficacy of alpha emitter Radium-223 in patients with bone metastases from radioactive iodine (RAI) refractory (RAIR) differentiated thyroid cancer. Methods RADTHYR is a multicenter, single-arm prospective Simon two-stage phase II trial (NCT02390934). The primary objective was to establish the efficacy of three administrations of 55 kBq/kg of Radium-223 by 18F-FDG PET/CT according to PERCIST criteria. Secondary objectives were to establish the efficacy of six administrations of Radium-223 by 18F-FDG PET/CT, 99mTc-HMDP bone scan and 18FNa PET/CT, clinical benefits, changes in serum bone markers, thyroglobulin levels, and safety. Results Ten patients were enrolled between July 2015 and December 2017 (4 M; median age 74 years). Prior to Radium-223 administration, patients received a median RAI cumulative activity of 15 GBq (7.4–35.6), external radiation therapy (n = 9), bone surgery (n = 8), cimentoplasty (n = 5), and cryoablation (n = 2). 18F-FDG PET/CT showed stable disease (SD) in 4/10 and progressive disease (PD) in 6/10 cases after three administrations and SD in 4/10, PD in 5/10 cases, and 1/10 non-evaluable (NE) case after six administrations. After six injections, 99mTc-HMDP bone scan showed SD in 9 cases and was NE in 1 case; 18FNa PET/CT showed SD in 8 cases, partial response (PR) in 1 case, and was NE in 1 case. No significant clinical benefits were reported during the study. A skeletal event occurred in 6 patients (median time without skeletal event of 12.1 months). Seventy-seven adverse events were reported during treatment (7 of grade 3–4). Three patients developed an acute myeloid, a promyelocytic, and a chronic myeloid leukemia after the last Radium-223 administration considered as drug-related. Conclusion The trial was stopped after interim analysis for lack of response of bone metastases from RAIR thyroid cancer to Radium-223. Severe hematological toxicity was observed in patients heavily pretreated with RAI and external radiation. Trial registration number NCT02390934. Registration date 18.03.2015. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05229-y.
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Garnon J, Jennings JW. Percutaneous Consolidation for Extraspinal Osteolytic Lesions: To Cementoplasty and Beyond. J Vasc Interv Radiol 2020; 31:659-660. [PMID: 32200944 DOI: 10.1016/j.jvir.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 01/20/2023] Open
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1 place de l'hôpital, 67096 Strasbourg, France.
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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