Outcome of Palliative Embolization of Bone Metastases in Differentiated Thyroid Carcinoma

Abstract

We investigated the effects of selective embolization in patients with symptomatic bone metastases of differentiated thyroid carcinoma. A total of 41 embolizations was performed in 16 patients. We studied the follow-up (range, 2 months to 8.6 yr) after the first embolization by evaluation of clinical symptoms and tumor dimensions. Success was defined as an improvement in clinical symptoms without tumor progression. The procedure was successful in 24 of 41 occasions (59%). Twenty-six embolizations were preceded or followed up by additional therapies, consisting of surgery (laminectomy), external irradiation, or radioiodine. Subgroup analysis revealed that these additional therapies did not influence the success rate; however, a potential effect on success duration may be present: for embolizations without additional radioiodine or external irradiation therapy, the median success duration was 6.5 months; for embolizations combined with additional radioiodine or external irradiation, this was 15 months (P = 0.0146). The ultimate outcome of the patients was unfavorable: nine patients died and five patients have progressive disease. We concluded that selective embolization of bone metastases may be considered a palliative therapy that may induce rapid, but transient, relief of symptoms. Combination with radioiodine or external irradiation may prolong the duration of success.

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…Experimental trials may be tried before external beam radiation in special circumstances, in part because of the morbidity of external beam radiation and its relative lack of efficacy. A small fraction of patients may benefit from radiofrequency ablation (213), ethanol ablation (214), or chemoembolization (215).…”

“…When skeletal metastatic lesions arise in locations where acute swelling may produce severe pain, fracture, or neurologic complications, external radiation and the concomitant use of glucocorticoids to minimize potential TSH-induced and/or radiation related tumor expansion should be strongly considered (261)-Recommendation C R66. Painful lesions that cannot be resected can also be treated by several options individually or in combination, including: radioiodine, external beam radiotherapy; intra-arterial embolization (215,262), radiofrequency ablation (263), periodic pamidronate or zoledronate infusions (with monitoring for development of possible osteonecrosis) (252), or bone-seeking radiopharmaceuticals such as strontium-89 or samarium-153 (264). While many of these modalities have been shown to relieve bone pain in cancer, they have not necessarily been reported to have been used in patients with thyroid cancer-Recommendation C R67.…”

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

“…Radiotherapy is also indicated for non-resectable metastases that do not exhibit 131 I uptake. Other procedures such as intra-arterial embolization, periodic pamidronate or zoledronate infusions, or cement injections may also be useful (185,186).…”

Selective embolization of thyroid arteries as a preresective and palliative treatment of thyroid cancer

“…On the other hand, there are some reports on the effective use of SETA in the treatment of vascular lesions of the thyroid arteries (Perona et al 1999, Jeganath et al 2001, Kos et al 2001, Garrett et al 2005. Also numerous studies have been performed on embolization of the skeletal metastases from the differentiated thyroid cancer (DTCs; Court et al 2000, Smit et al 2000, van Tol et al 2000, Eustatia-Rutten et al 2003, Lorenz et al 2005. The number of studies on SETA application in primary thyroid cancer is limited and they are based on small number of patients (Beers et al 1985, Ramos et al 2004, Tazbir et al 2005.…”