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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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Navarro-Gonzalez E. Use of multikinase inhibitors/lenvatinib concomitant with antiresorptive therapy for bone metastases from radioiodine-resistant differentiated thyroid cancer. Cancer Med 2022; 11 Suppl 1:54-58. [PMID: 35785524 PMCID: PMC9537057 DOI: 10.1002/cam4.4983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/06/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Bone is the second most common distant metastasis site in differentiated thyroid cancer (DTC) and is normally associated with the presence of other metastases, which are usually radioiodine‐resistant. The presence of bone metastasis (BM) determines low survival and greater morbidity due to the frequency of skeletal‐related events (SREs), which can be a serious complication of BM. There is evidence that antiresorptive therapy (AT) reduces SREs in other solid tumors, but not yet in DTC BM, for which data are scant. The same is true for systemic therapy with multikinase inhibitors (MKIs). In general, the results for MKI use are well known, although the effect on BM has rarely been evaluated. While MKIs are indicated in current clinical practice guidelines, studies evaluating the benefits and risks of concomitant treatment with MKIs and AT are lacking, and the available data come from small samples in retrospective studies. The objective of this article is to review the latest evidence for concomitant MKIs and AT. Bone is a common distant metastasis in differentiated thyroid cancer, that is associated with the presence of other metastases, low survival and high morbidity. There is evidence that antiresorptive therapy and multikinase inhibitors reduce skeletal‐related events in other solid tumors, but studies evaluating the benefits and risks of concomitant treatment are lacking in differentiated thyroid cancer. This article reviews the latest evidence.
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Affiliation(s)
- Elena Navarro-Gonzalez
- Department of Endocrinology and Nutrition, University Hospital Virgen del Rocío, Sevilla, Spain
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3
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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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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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Kim EH, Kim MS, Takahashi A, Suzuki M, Vares G, Uzawa A, Fujimori A, Ohno T, Sai S. Carbon-Ion Beam Irradiation Alone or in Combination with Zoledronic acid Effectively Kills Osteosarcoma Cells. Cancers (Basel) 2020; 12:cancers12030698. [PMID: 32187978 PMCID: PMC7140041 DOI: 10.3390/cancers12030698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Osteosarcoma (OSA) is the most common malignant bone tumor in children and adolescents. The overall five-year survival rate for all bone cancers is below 70%; however, when the cancer has spread beyond the bone, it is about 15–30%. Herein, we evaluated the effects of carbon-ion beam irradiation alone or in combination with zoledronic acid (ZOL) on OSA cells. Carbon-ion beam irradiation in combination with ZOL significantly inhibited OSA cell proliferation by arresting cell cycle progression and initiating KHOS and U2OS cell apoptosis, compared to treatments with carbon-ion beam irradiation, X-ray irradiation, and ZOL alone. Moreover, we observed that this combination greatly inhibited OSA cell motility and invasion, accompanied by the suppression of the Pi3K/Akt and MAPK signaling pathways, which are related to cell proliferation and survival, compared to individual treatments with carbon-ion beam or X-ray irradiation, or ZOL. Furthermore, ZOL treatment upregulated microRNA (miR)-29b expression; the combination with a miR-29b mimic further decreased OSA cell viability via activation of the caspase 3 pathway. Thus, ZOL-mediated enhancement of carbon-ion beam radiosensitivity may occur via miR-29b upregulation; co-treatment with the miR-29b mimic further decreased OSA cell survival. These findings suggest that the carbon-ion beam irradiation in combination with ZOL has high potential to increase OSA cell death.
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Affiliation(s)
- Eun Ho Kim
- Department of Biochemistry, School of Medicine, Daegu Catholic University, Nam-gu, Daegu 42472, Korea
- Correspondence: (E.H.K.); (S.S.); Tel.: +82-53-650-4480 (E.H.K.); +81-43-206-3231 (S.S.)
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Korea;
| | - Akihisa Takahashi
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan;
| | - Masao Suzuki
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (M.S.); (A.U.); (A.F.)
| | - Guillaume Vares
- Cell Signal Unit, Okinawa Institute of Science and Technology Graduate University (OIST), Onna-son 904-0495, Okinawa, Japan;
| | - Akiko Uzawa
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (M.S.); (A.U.); (A.F.)
| | - Akira Fujimori
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (M.S.); (A.U.); (A.F.)
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan;
| | - Sei Sai
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan; (M.S.); (A.U.); (A.F.)
- Correspondence: (E.H.K.); (S.S.); Tel.: +82-53-650-4480 (E.H.K.); +81-43-206-3231 (S.S.)
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Iñiguez-Ariza NM, Bible KC, Clarke BL. Bone metastases in thyroid cancer. J Bone Oncol 2020; 21:100282. [PMID: 32154098 PMCID: PMC7058902 DOI: 10.1016/j.jbo.2020.100282] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Osseous metastases (OMs) occur in only 4% of all thyroid cancer patients but are associated with greatly increased morbidity and mortality. OMs are about twice as frequent in follicular, hurthle cell, and medullary thyroid cancers as compared to papillary thyroid cancers. OMs are often lytic, triggered via activation of osteoclasts by tumor cells in a “vicious cycle”. OMs are often initially asymptomatic, but associated with eventual skeletal related events in >75%. Early identification of OMs, preemptive treatment with antiresorptive agents, and aggressive treatment of focal lesions before crisis are key.
Whereas preemptive screening for the presence of lymph node and lung metastases is standard-of-care in thyroid cancer patients, bone metastases are less well studied and are often neglected in thyroid cancer patient surveillance. Bone metastases in thyroid cancer are, however, independently associated with poor/worse prognosis with a median overall survival from detection of only 4 years despite an otherwise excellent prognosis for the vast majority of thyroid cancer patients. In this review we summarize the state of current knowledge as pertinent to bony metastatic disease in thyroid cancer, including clinical implications, impacts on patient function and quality of life, pathogenesis, and therapeutic opportunities, proposing approaches to patient care accordingly. In particular, bone metastasis pathogenesis appears to reflect cooperatively between cancer and the bone microenvironment creating a “vicious cycle” of bone destruction rather than due exclusively to tumor invasion into bone. Additionally, bone metastases are more frequent in follicular and medullary thyroid cancers, requiring closer bone surveillance in patients with these histologies. Emerging data also suggest that treatments such as multikinase inhibitors (MKIs) can be less effective in controlling bone, as opposed to other (e.g. lung), metastases in thyroid cancers, making special attention to bone critical even in the setting of active MKI therapy. Although locoregional therapies including surgery, radiotherapy and ablation play important roles in palliation, antiresorptive agents including bisphosphonates and denosumab appear individually to delay and/or lessen skeletal morbidity and complications, with dosing frequency of every 3 months appearing optimal; their early application should therefore be strongly considered.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW Rochester, MN, 55905, USA.,Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080 Ciudad de México, Mexico City, Mexico
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW Rochester, MN, 55905, USA
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The medical treatment of radioiodine-refractory differentiated thyroid cancers in 2019. A TUTHYREF® network review. Bull Cancer 2019; 106:812-819. [DOI: 10.1016/j.bulcan.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/07/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
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Wu D, Gomes Lima CJ, Moreau SL, Kulkarni K, Zeymo A, Burman KD, Wartofsky L, Van Nostrand D. Improved Survival After Multimodal Approach with 131I Treatment in Patients with Bone Metastases Secondary to Differentiated Thyroid Cancer. Thyroid 2019; 29:971-978. [PMID: 31017051 DOI: 10.1089/thy.2018.0582] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The objective of this study was to evaluate the overall survival (OS) of radioiodine (131I) treatments alone or combined with non-131I treatments in patients with bone metastases (BM) of differentiated thyroid cancer (DTC). Methods: This was a retrospective study of patients who were evaluated between 2001 and 2018 at MedStar Washington Hospital Center and who had DTC, BM, and at least one 131I treatment after the diagnosis of BM. The OS was analyzed by Kaplan-Meier survival curves and was compared by log-rank test between two groups: patients who received 131I treatments alone and those who received treatments combining 131I with non-131I treatments (CombTx). Non-131I treatments include surgery, radiofrequency ablation, cryotherapy, arterial embolization, external beam radiation, Cyberknife, systemic targeted therapy, and anti-resorptive medication. Results: A total of 77 patients met the above criteria and were followed up to 41 years. Thirty percent (23/77) of patients received 131I treatment alone, and 70% (54/77) received CombTx. For 131I treatment alone, the median survival was 3.9 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 86%, 81%, 61%, 35%, and 23%, respectively. For CombTx, the median survival was 7.7 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 96%, 92%, 86%, 69%, and 30%, respectively. Patients who had undergone initial 131I therapy within six months post thyroidectomy demonstrated a better median survival after BM diagnosis than those whose initial 131I therapy was six months or more after thyroidectomy (6.5 vs. 0.5 years; p < 0.001). Patients who received external beam radiation therapy demonstrated a better median survival than those who did not (7.8 vs. 4.4 years; p = 0.016). Patients who received denosumab demonstrated a better median survival than those who did not (7.7 vs. 5.2 years; p = 0.03). Patients who were <55 years of age at the initial diagnosis of DTC or at the initial diagnosis of BM had a better median OS than those diagnosed at ≥55 years of age (both p = 0.01). In the multivariate analysis, only age at initial diagnosis of DTC and initial 131I therapy within six months post thyroidectomy, and multiple 131I treatments were independent prognostic factors. Conclusions: In patients with DTC with BM, 131I treatment in combination with one or more non-131I direct and systemic treatments was associated with a significant increase in OS compared with those patients who were treated by 131I treatment alone.
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Affiliation(s)
- Di Wu
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
| | - Cristiane J Gomes Lima
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Shari L Moreau
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kanchan Kulkarni
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Alexander Zeymo
- 5Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Kenneth D Burman
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Leonard Wartofsky
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Douglas Van Nostrand
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
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Andrade F, Probstner D, Decnop M, Bulzico D, Momesso D, Corbo R, Vaisman M, Vaisman F. The Impact of Zoledronic Acid and Radioactive Iodine Therapy on Morbi-Mortality of Patients with Bone Metastases of Thyroid Cancer Derived from Follicular Cells. Eur Thyroid J 2019; 8:46-55. [PMID: 30800641 PMCID: PMC6381918 DOI: 10.1159/000493190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Bone metastases bring greater morbi-mortality to patients with differentiated thyroid carcinoma (DTC). Treatment was limited to radioactive iodine (RAI) and local approaches. Currently, bisphosphonates are included in the therapeutic arsenal. The aim of this study is to evaluate the impact of bone metastases and their treatment with zoledronic acid (ZA) and RAI therapy. METHODS We retrospectively review 50 DTC patients with structurally evident bone metastases followed in a tertiary cancer center from 1994 to 2018. Clinical-pathologic characteristics, skeletal related events (SRE), and therapeutic approaches were recorded. RESULTS Among the 50 patients analyzed, 22 underwent ZA adjuvant therapy and 28 did not. Mortality rate was 44%. Those patients presented SREs more frequently (90.9 vs. 67.9% the survival group, p = 0.05) and also had a greater number of bone lesions (40.9 vs. 10.7% had more than 6 metastatic sites, p = 0.03). The same group of patients was analyzed before and after therapy with ZA and the incidence of SRE decreased from 1.81 (0-8) before therapy to 0.29 (0-7) after therapy (p = 0.006). Comparing similar groups of 22 patients treated with ZA with 28 patients not treated, there was a trend of better overall survival (OS) in the group that received this drug (147 vs. 119 months, p = 0.06) and significantly improvement when bone metastases were RAI avid 155 (125-185) versus 120 (85-157) months, p < 0.01. Conclusion : ZA can successfully diminish the chance of having new SRE and possibly affect OS in DTC patients with bone metastases. The positive impact of RAI adjuvant treatment on OS is directly associated with RAI uptake.
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Affiliation(s)
- Fernanda Andrade
- Department of Medicine, Endocrinology Service, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
- Department of Medicine, Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Danielle Probstner
- Department of Orthopedics and palliative care, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | - Marcus Decnop
- Department of Radiology, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | - Daniel Bulzico
- Department of Medicine, Endocrinology Service, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | - Denise Momesso
- Department of Medicine, Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Rossana Corbo
- Department of Medicine, Endocrinology Service, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
- Department of Medicine, Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Mario Vaisman
- Department of Medicine, Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Fernanda Vaisman
- Department of Medicine, Endocrinology Service, Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
- Department of Medicine, Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
- *Fernanda Vaisman, MD, PhD, Endocrinology Service, Department of Medicine, Instituto Nacional do Cancer José Alencar Gomes da Silva, INCA, HC 1, Praça da Cruz Vermelha, 23, Centro, Rio de Janeiro, RJ 20231-083 (Brazil), E-Mail
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Matrone A, Campopiano MC, Nervo A, Sapuppo G, Tavarelli M, De Leo S. Differentiated Thyroid Cancer, From Active Surveillance to Advanced Therapy: Toward a Personalized Medicine. Front Endocrinol (Lausanne) 2019; 10:884. [PMID: 31998228 PMCID: PMC6961292 DOI: 10.3389/fendo.2019.00884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Differentiated thyroid cancer (DTC) is the most frequent endocrine malignancy and represents the most rapidly increasing cancer diagnosis worldwide. In the last 20 years, this increase has been mostly due to a higher detection of small papillary thyroid cancers, with doubtful effects on patients' outcome. In fact, despite this growth, cancer-related death remained stable over the years. The growing detection of microcarcinomas associated to the indolent behavior of these cancers led to the development of strategies of active surveillance in selected centers of different countries. Moreover, toward a more personalized approach in the management of DTC patients, surgical treatments became more conservative, favoring less extensive options in patients at low risk of recurrence. The rise in lobectomy in low-risk cases and the need to avoid further therapies, with controversial impact on recurrences and cancer-related death in selected intermediate risk cases, led to reconsider the use of radioiodine treatment, too. Since clinicians aim to treat different patients with different modalities, the cornerstone of DTC follow-up (i.e., thyroglobulin, thyroglobulin autoantibodies, and neck ultrasound) should be interpreted consistently with this change of paradigm. The introduction of novel molecular target therapies (i.e., tyrosine kinase inhibitors), as well as a better understanding of the mechanisms of immune checkpoint inhibitor therapies, is radically changing the management of patients with advanced DTC, in whom no treatment option was available. The aim of this review is to analyze the most recent developments of the management of DTC, focusing on several key issues: active surveillance strategies, initial treatment, dynamic risk re-stratification, and therapeutic options in advanced DTC.
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Affiliation(s)
- Antonio Matrone
- Endocrinology Unit 1, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Antonio Matrone
| | - Maria Cristina Campopiano
- Endocrinology Unit 1, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, School of Medicine, Cittá della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giulia Sapuppo
- Division of Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Martina Tavarelli
- Division of Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Simone De Leo
- Division of Endocrine and Metabolic Diseases, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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11
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Califano I, Deutsch S, Löwenstein A, Cabezón C, Pitoia F. Outcomes of patients with bone metastases from differentiated thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:14-20. [PMID: 29694635 PMCID: PMC10118682 DOI: 10.20945/2359-3997000000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
Abstract
Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.
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12
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Li P, Hu Y. "Turn-Off" Fluorescent Sensor for Pamidronate Disodium and Zoledronic Acid Based on Newly Synthesized Carbon Dots from Black Tea. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2018; 2018:3631249. [PMID: 29725552 PMCID: PMC5872615 DOI: 10.1155/2018/3631249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 05/14/2023]
Abstract
As common bisphosphonates drugs, pamidronate disodium and zoledronic acid have been widely investigated for bone metastases. In this paper, a new "turn-off" model based on carbon dots (CDs) from black tea was established to analyze the two kinds of bisphosphonate drugs, pamidronate disodium and zoledronic acid. Through the new sensor, both of drugs can be quantitative, respectively, with the limit of detection of 5 × 10-9 mol·L-1 and 6 × 10-9 mol·L-1. In addition, the fluorescence of newly prepared CDs can be quenched by two drugs with various degrees via photoinduced electron transfer, which can be perfectly used to distinguish them. Most importantly, this turn-off method has been employed to analyze the two drugs under the influence of foreign interference factors. This method provides a new view and guidance for the rapid analysis and recognition of drugs for bone metastases in vitro and in vivo.
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Affiliation(s)
- Peng Li
- The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300071, China
| | - Yongcheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China
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13
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Metástasis a distancia en cáncer diferenciado de tiroides: diagnóstico y tratamiento. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.raem.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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14
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Osorio M, Moubayed SP, Su H, Urken ML. Systematic review of site distribution of bone metastases in differentiated thyroid cancer. Head Neck 2017; 39:812-818. [DOI: 10.1002/hed.24655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marcela Osorio
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Sami P. Moubayed
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
| | - Henry Su
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Mark L. Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
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15
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Xu JY, Murphy WA, Milton DR, Jimenez C, Rao SN, Habra MA, Waguespack SG, Dadu R, Gagel RF, Ying AK, Cabanillas ME, Weitzman SP, Busaidy NL, Sellin RV, Grubbs E, Sherman SI, Hu MI. Bone Metastases and Skeletal-Related Events in Medullary Thyroid Carcinoma. J Clin Endocrinol Metab 2016; 101:4871-4877. [PMID: 27662441 PMCID: PMC5155685 DOI: 10.1210/jc.2016-2815] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Bone metastases (BM) can lead to devastating skeletal-related events (SREs) in cancer patients. Data regarding medullary thyroid carcinoma (MTC) with BM are lacking. OBJECTIVE We evaluated the natural history of BM and SREs in MTC patients identified by a cancer center tumor registry. SETTING The study was conducted at a tertiary cancer center. PATIENTS AND MAIN OUTCOME MEASURES We retrospectively reviewed the charts of MTC patients with BM who received care from 1991 to 2014 to characterize BM and SREs. RESULTS Of 1008 MTC patients treated, 188 were confirmed to have BM (19%), of whom 89% (168 of 188) had nonosseous distant metastases. Median time from MTC to BM diagnosis was 30.9 months (range 0-533 mo); 25% (45 of 180) had BM identified within 3 months of MTC diagnosis. Median follow-up after detecting BM was 1.6 years (range 0-23.2 y). Most patients (77%) had six or more BM lesions, most often affecting the spine (92%) and pelvis (69%). Many patients (90 of 188, 48%) experienced one or more SREs, most commonly radiotherapy (67 of 90, 74%) followed by pathological fracture (21 of 90, 23%). Only three patients had spinal cord compression. Patients with more than 10 BM lesions were more likely to experience SREs (odds ratio 2.4; P = .007), with no difference in 5-year mortality after MTC diagnosis between patients with (31%) and without SREs (23%) (P = .11). CONCLUSIONS In this large retrospective series, BM in MTC was multifocal, primarily involving the spine and pelvis, supporting screening these regions for metastases in at-risk patients. SREs were common but spinal cord compression was rare. Antiresorptive therapies in this population should be investigated further with prospective trials.
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Affiliation(s)
- Jian Yu Xu
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - William A Murphy
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Denái R Milton
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Camilo Jimenez
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Sarika N Rao
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Mouhammed Amir Habra
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Steven G Waguespack
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Ramona Dadu
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Robert F Gagel
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Anita K Ying
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Maria E Cabanillas
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Steven P Weitzman
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Naifa L Busaidy
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Rena V Sellin
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Elizabeth Grubbs
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Steven I Sherman
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
| | - Mimi I Hu
- Departments of Endocrine Neoplasia and Hormonal Disorders (J.Y.X., C.J., S.N.R., M.A.H., S.G.W., R.D., R.F.G., A.K.Y., M.E.C., S.P.W., N.L.B., R.V.S., S.I.S., M.I.H.), Radiology (W.A.M.), Biostatistics (D.R.M.), and Endocrine Surgery (E.G.), University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402
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16
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Choi YM, Kim WG, Kwon H, Jeon MJ, Lee JJ, Ryu JS, Hong EG, Kim TY, Shong YK, Kim WB. Early prognostic factors at the time of diagnosis of bone metastasis in patients with bone metastases of differentiated thyroid carcinoma. Eur J Endocrinol 2016; 175:165-72. [PMID: 27272238 DOI: 10.1530/eje-16-0237] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/07/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Bone is the second most common site of distant metastases from differentiated thyroid cancer (DTC). Patients with bone metastases were associated with poor clinical outcomes; however, their clinical courses are heterogeneous. The aim of this study is to evaluate early prognostic factors of patients with bone metastases from DTC at the time of diagnosis of bone metastasis. METHODS This retrospective study included 93 patients with bone metastases from DTC. We defined 'Pre-RAIT group' as patients whose bone metastases were detected before initial RAIT. The 'post-RAIT group' was defined as patients whose bone metastases were detected after initial RAIT or during the follow-up period. RESULTS Median age was 55.4years, and 55 patients (59%) had papillary thyroid cancer. Patients in the pre-RAIT group (n=32) demonstrated significantly poorer overall survival (OS) (HR=1.86, P=0.04) than those in the post-RAIT group. There was no significant difference in the OS according to the initial RAI avidity among all patients (P=0.18). RAI-avid bone metastases had better OS only in the pre-RAIT group (HR=0.23, P=0.01) but not in the post-RAIT group. In the post-RAIT group, older age (>45years), elevated serum thyroglobulin (Tg) level (>250ng/mL), and the presence of skeletal-related events (SREs) were significantly associated with poor OS. RAI avidity was not a significant prognostic factor in the post-RAIT group (P=0.33). CONCLUSIONS Patients whose bone metastases were diagnosed before initial RAIT demonstrate a poorer prognosis. RAI avidity is an early prognostic indicator in the pre-RAIT group. Old age, higher serum Tg levels, and SRE are associated with poor survival outcomes in the post-RAIT group.
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Affiliation(s)
- Yun Mi Choi
- Division of EndocrinologyDepartment of Internal Medicine Department of Internal MedicineHallym University Dongtan Sacred Heart Hospital, Gyeonggi-Do, South Korea
| | - Won Gu Kim
- Division of EndocrinologyDepartment of Internal Medicine
| | - Hyemi Kwon
- Division of EndocrinologyDepartment of Internal Medicine
| | - Min Ji Jeon
- Division of EndocrinologyDepartment of Internal Medicine
| | - Jong Jin Lee
- Department of Nuclear MedicineAsan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- Department of Nuclear MedicineAsan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Gyoung Hong
- Department of Internal MedicineHallym University Dongtan Sacred Heart Hospital, Gyeonggi-Do, South Korea
| | - Tae Yong Kim
- Division of EndocrinologyDepartment of Internal Medicine
| | | | - Won Bae Kim
- Division of EndocrinologyDepartment of Internal Medicine
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