Background. Bone is a frequent site of metastasis from thyroid carcinoma, but prognostic factors for patients who have surgery for thyroid carcinoma bone metastases are poorly understood. Methods. A retrospective review at a single institution identified 41 patients that underwent surgery in the appendicular skeleton for thyroid carcinoma bone metastasis from 1988 to 2011. Results. Overall patient survival probability by Kaplan-Meier analysis after surgery for bone metastasis was 72% at 1 year, 29% at 5 years, and 20% at 8 years. Patients who had their tumor excised (P = 0.001) or presented with solitary bone involvement had a lower risk of death following surgery adjusting for age and gender. Disease progression at the surgery site occurred more frequently with a histological diagnosis of follicular carcinoma compared with other subtypes (P = 0.023). Multivariate analysis showed that tumor subtype, chemotherapy, and preoperative radiation treatment had no effect on survival after surgery. Patients treated with radioactive iodine had better survival following thyroidectomy, but not following surgery for bone metastases. Conclusions. For patients undergoing surgery for thyroid cancer bone metastasis, resection of the bone metastasis, if possible, has a survival benefit.
Background/Objective: Metastatic colorectal carcinoma to bone rarely requires surgical intervention, and is infrequently studied. Aggressive surgical resection is sometimes empirically recommended in these patients, although there is no proven benefit for patient survival. Our hypothesis was that there is survival advantage conferred by resecting bone metastases (BM) when surgery is necessary. Methods:We performed a retrospective review of a prospectively collected database and identified 39 patients with bone metastases in the appendicular skeleton requiring surgery. Patients underwent surgery because of intractable pain, impending pathologic fracture, and/or pathologic fracture at presentation.Results: Median survival after complete resection of bone metastasis was higher (8 months) than for patients who had surgery, but did not have bony metastases completely excised (3 months, p = 0.014); and in surgical patients who had solitary bone metastasis at presentation (p = 0.023) compared with multiple bone involvement. There were no perioperative deaths. Additional skeletal surgeries were only required for patients (4 out of 39) with local recurrences. In cases of local recurrence, the median time to progression was 19 months. Conclusions:Surgery for bone metastasis in colorectal carcinoma is well tolerated, and can be considered for palliative care. Compared with other surgical techniques, complete bone-metastasis resection is associated with longer overall survival, and with longer recurrence free survival.
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