Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience

Brown, Aaron; Greening, W P; McCready, V. R.; Shaw, H. J.; Harmer, C.

doi:10.1259/0007-1285-57-676-323

Cited by 194 publications

(86 citation statements)

References 8 publications

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“…The levels above and below the vertebrectomy site were counted as parts of the anterior column construct when plating, Steinmann pins, or chest tube insertion were involved. Fourteen patients did not require posterolateral stabilization; of those who did, the median length of the construct was 6 vertebral levels (range [3][4][5][6][7][8][9][10][11][12][13][14]. Two patients underwent lumbopelvic or lumbosacropelvic fixation; in these instances, the sacrum or pelvis was treated as 1 level.…”

Section: Operative Datamentioning

confidence: 99%

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Sellin

Suki

Harsh

et al. 2015

SPI

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OBJECT Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival. METHODS The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center. RESULTS Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8–27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7–62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46–23.30], p < 0.001; and HR 2.86 [95% CI 1.30–6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34–6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20–0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06–0.93] p = 0.04; and OR 1.24 [95% CI 1.02–1.52], p = 0.03), but not the multivariate analysis. CONCLUSIONS Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.

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Section: Operative Datamentioning

confidence: 99%

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Sellin

Suki

Harsh

et al. 2015

SPI

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“…However, studies using radioactive iodine therapy for bone metastases have shown that the metastases are generally resistant to 131 I and may require other approaches [14]. Brown et al [15] reported no 10-year survivors in a group of patients with bone metastases treated with 131 I, but a 54 % 10-year survival rate for patients with lung metastases. Moreover, a previous retrospective study evaluated the therapeutic outcome, total administered radioiodine activity, and side effects in 107 patients with initial bone metastases [16].…”

Section: Discussionmentioning

confidence: 99%

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Zhang

Yin

et al. 2012

Eur Spine J

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Purpose The aim of this study was to discuss the clinical presentation, imaging findings, treatments received, and outcome of therapies for patients with epidural spinal cord compression caused by thyroid spinal metastases, with the goal of emphasizing the importance of surgery in this setting and discussing therapeutic plan for treating these patients. Methods A total of 22 patients with spinal cord compression due to thyroid tumor spinal metastases who received surgery in our department were identified from 2004 to 2011. The series of 22 patients collected from our institution over the past 7 years was used to discuss treatment options for thyroid cancer spinal metastases on the basis of literature review and our own extensive experience. Results The mean age of the patients in this study was 57 years (range 37-78 years). The duration of the preoperative symptoms was 1-24 months, with an average of approximately 6 months. All patients attained improvement of at least one level of the Frankel classification after surgery. Two patients received more than one operation at our institution. Two patients died during follow-up, two patients had stable disease, and all other patients maintained a disease-free status during follow-up.Conclusions As thyroid tumor spinal metastases have a favorable prognosis, a radical therapeutic attitude should be considered in decision-making. Dorsal spinal decompression through curettage and stabilization can preserve or restore neurological function for most patients. For patients who have more than one metastatic lesion of the spine, surgeries can be sequentially performed based on the urgency of the case. In addition to treatment of primary disease, surgery and bisphosphonate treatment are the most important therapies for these patients.

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“…These patients had also received high cumulative doses of '3'I (Schlumberger et al, 1996). Hence, more investigations are necessary to assess the respective role of high activities of 131I and of external beam radiotherapy (Brown et al, 1984;Edmonds et al, 1986;Brinker et al, 1987). This result is strengthened by the fact that the dose from3'1I delivered to bone marrow could be higher in thyroid cancer patients than estimated in ICRP tables for euthyroid subjects (ICRP, 1988), because the hypothyroid status of these patients decreases the renal clearance of 1311, thus increasing the whole body retention of 1311 and the mean whole body radiation dose.…”

Section: Discussionmentioning

confidence: 99%

Leukaemias and cancers following iodine-131 administration for thyroid cancer

Vathaire

Schlumberger²,

Delisle³

et al. 1997

Br J Cancer

125

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Summary We studied 1771 patients treated for a thyroid cancer in two institutions. None of these patients had been treated with external radiotherapy and 1497 had received 1311. The average 1311 cumulative activity administered was 7.2 GBq, and the estimated average dose was 0.34 Sv to the bone marrow and 0.80. Sv to the whole body. After a mean follow-up of 10 years, no case of leukaemia was observed, compared with 2.5 expected according to the coefficients derived from Japanese atomic bomb survivors (P = 0.1). A total of 80 patients developed a solid second malignant neoplasm (SMN), among whom 13 developed a colorectal cancer. The risk of colorectal cancer was found to be related to the total activity of 1311 administered 5 years or more before its diagnosis (excess relative risk = 0.5 per GBq, P = 0,02).These findings were probably caused by the accumulation of 1311 in the colon lumen. Hence, in the absence of laxative treatment, the dose to the colon as a result of 1311 administered for the treatment of thyroid cancer could be higher than expected from calculation of the International Commission on Radiological Protection (ICRP). When digestive tract cancers were excluded, the overall excess relative risk of second cancer per estimated effective sievert received to the whole body was -0.2 (P = 0.6).Keywords: radiocarcinogenesis; carcinogenic effects of 1311; protracted exposure to radiation; thyroid cancer On account of the small population dose involved, published studies (IARC, 1994) of nuclear industry workers do not have sufficient power to make reliable comparisons with the risks estimated from the Japanese atomic bomb survivors (UNSCEAR, 1994). Hence, studies of adult populations undergoing protracted exposure to radiation for medical reasons are still necessary. For this purpose, '3'I is a suitable model, because its physical halflife is 8 days. The risks of solid tumours and leukaemia after administration of '3'I have been studied in several cohorts of adults (Hall et al 1991(Hall et al , 1992 Dottorini et al, 1995); nevertheless, the statistical power of these studies is still insufficient to derive precise coefficients.Another reason for studying the carcinogenic effects of '3'I is the fact that considerable amounts of various radioisotopes of iodine, including '3'I, were released in the atmosphere during the Chernobyl accident. A substantial increase in thyroid cancer incidence has been observed in children living in the most heavily contaminated areas at the time of the accident (Stsjazhko et al. 1995), but no increased incidence of other malignancies, including leukaemia, has been reported so far. More data are thus needed to predict future risks in populations that have been contaminated.We report the results of a study of 1771 patients treated for a thyroid cancer, of whom 651 had received 1311 for diagnosis, and 846 for therapy. Among the 2479 patients, 173 patients were excluded because they had died or were lost to follow-up during the first two years after the diagnosis of thyroid cancer; ...

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Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience

Cited by 194 publications

References 8 publications

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Leukaemias and cancers following iodine-131 administration for thyroid cancer

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