Spine Stereotactic Radiosurgery for Patients with Metastatic Thyroid Cancer: Secondary Analysis of Phase I/II Trials

Bernstein, M.; Chang, Eric L.; Amini, Behrang; Pan, Hubert Y.; Cabanillas, Maria E.; Wang, Xin A.; Allen, Pamela K.; Rhines, Laurence D.; Tatsui, Claúdio E.; Li, Jing; Brown, Paul D.; Ghia, Amol J.

doi:10.1089/thy.2016.0046

Cited by 35 publications

(35 citation statements)

References 28 publications

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“…Some papers have reported that spine SBRT achieved good local control even for the so-called radioresistant histopathologies, including sarcoma, 20 thyroid cancer, 21 renal cell carcinoma, 22 and melanoma. 16 The biological rationale for these observations may be explained by experimental data suggesting that only high-dose-per-fraction SBRT, typically exceeding 8 to 10 Gy per fraction, activates pathways to enhance cell death, particularly via the sphingomyelinase pathway within tumor endothelium.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution

Ito

Ogawa

Shimizuguchi

et al. 2018

Technol Cancer Res Treat

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Object:This study aimed to clarify the outcomes of stereotactic body radiotherapy for spinal metastases with a uniform dose fractionation schedule in our institution.Materials and Methods:Patients treated with spine stereotactic body radiotherapy were retrospectively reviewed. The prescribed dose was 24 Gy in 2 fractions. End points were local control, pain control, and adverse events. Local control was defined as elimination, shrinkage, or stable disease in the tumor on imaging evaluations. Pain status was measured on a scale of 0 to 10 by patients’ self-reports, and pain response was defined as the time at which pain scale score decreased by 2 or more from the baseline score without increase in analgesics. In addition, various treatment- and tumor-specific factors were evaluated to determine predictive values for local and pain control.Results:This study included 134 lesions in 131 patients, with: lesion histopathology, lung/colorectal/thyroid/renal/breast/prostate/sarcoma/other cancer, 24/22/18/14/12/10/6/25; reirradiation stereotactic body radiotherapy, 82 (61.2%) cases; and postoperative stereotactic body radiotherapy for epidural spinal cord compression, 45 (33.6%) cases. Median follow-up after stereotactic body radiotherapy was 9 months. The 1-year local control rate was 72.3%. Seventy (79.5%) of the 88 cases with pain from spinal metastases achieved pain response. The 1-year pain progression-free rate was 61.7%. Regarding metastases from colorectal cancer, local and pain control rates at 1 year were significantly lower compared with other cancer types (local control rate, 34.1% vs 81.8%; P < .01; pain progression-free rate, 36.9% vs 69.9%; P = .02). On multivariate analysis, colorectal cancer metastases and radiation history were identified as independent predictors of lower local and pain control rates. Radiation-induced myelopathy, radiculopathy, and vertebral compression fractures were observed in 0, 2 (1.5%), and 16 (11.9%) cases, respectively.Conclusions:This study showed that spine stereotactic body radiotherapy achieved good local and pain control, with a clinically acceptable safety profile. However, stereotactic body radiotherapy may be less effective against spinal metastases from colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution

Ito

Ogawa

Shimizuguchi

et al. 2018

Technol Cancer Res Treat

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“…[ 5 ] EBRT is a palliative treatment indicated only when pain, risk of fracture, and neurological complications of spinal cord compression are present. [ 12 – 14 ] Radioiodine therapy is considered the first-line treatment for sodium-iodide symporter (NIS) positive metastatic lesions. TSH suppression therapy intends to reduce the impetus for further tumor growth.…”

Section: Discussionmentioning

confidence: 99%

An upper cervical cord compression secondary to occult follicular thyroid carcinoma metastases successfully treated with multiple radioiodine therapies

Dong

Ni²,

Li³

et al. 2017

Medicine

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Rationale:The spine is the most common site of bone metastases due to thyroid cancer; however, spinal cord compression as a complication of metastatic thyroid cancer is very rare.Patient concerns:A 48-year-old female patient was presented to the Neurosurgical Department, complaining of progressive back neck pain with bilateral upper extremities numbness and weakness for 4 months.Diagnosis:Imaging studies revealed osteolytic destruction in bodies and accessories of the second and third cervical vertebrae with a huge soft-tissue mass compressing spinal cord and causing swelling. After the neurosurgical decompression surgery, the pathological examination established a metastatic follicular carcinoma originating from the thyroid gland.Interventions:Her cervical spinal metastases were hardly removed by surgery and the risks of external beam radiation therapy (EBRT) were very high. So she underwent a total thyroidectomy and received multiple radioiodine (RAI) and concomitant glucocorticoid therapies postoperatively. Radioiodine whole-body scan (WBS) showed multiple abnormal radioiodine uptakes. Then single-photon emission tomography/computed tomography (SPECT/CT) located these spinal metastases involving cervical, lumbar, and sacral vertebrae.Outcomes:After 5 times RAI therapy, her thyroglobulin obviously decreased, with the cervical lesion shrinkage and no spinal cord edema.Lessons:RAI therapy and concomitant glucocorticoid therapy could be used for spinal metastases of FTC, even with spinal cord compression.

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“…Differentiated thyroid carcinoma (DTC) is one of the primary pathogenic tumors associated with the development of spinal metastases. 1 DTC is the most common thyroid carcinoma representing 90% of cases overall, consisting of papillary carcinoma (70-75%) and follicular carcinoma (15-20%). 2 The prognosis of patients with thyroid carcinoma is good, and the 10-year survival rate is around 90%; however, the presence of distant metastases is related to a significant reduction in life expectancy.…”

Section: Introductionmentioning

confidence: 99%

“…2 The prognosis of patients with thyroid carcinoma is good, and the 10-year survival rate is around 90%; however, the presence of distant metastases is related to a significant reduction in life expectancy. 1 Indeed, up to 68% of thyroid carcinoma patients develop spinal metastases and the clinical prognosis of this group of patients is poor. [3][4][5][6][7] The presence of metastatic spinal differentiated thyroid carcinoma (MSDTC) significantly increases the incidence of complications and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…1,8 In addition, spinal metastases from thyroid carcinoma are 3-4 times more likely to cause spinal cord compression than metastatic tumors from breast or prostate cancer, and up to 13% of thyroid carcinoma patients may have pathological fractures resulting from spinal metastases. 1,5,8 The treatment of MSDTC has evolved from surgery and radiation therapy to a multidisciplinary comprehensive treatment strategy, including spinal surgery, general surgery, radiotherapy, nuclear medicine and endocrinology. The main focus of treatment is usually to control the primary lesions rather than to treat metastatic spinal lesions, which may lead to a serious decline in quality of life.…”

Section: Introductionmentioning

confidence: 99%

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<p>A Single-Center, 10-Year Retrospective Study on Surgical Treatment and Prognosis Analysis of Differentiated Thyroid Carcinoma with Spinal Metastasis</p>

Liu¹,

Zhou²,

Song³

et al. 2020

CMAR

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Metastatic spinal differentiated thyroid carcinoma (MSDTC) is relatively rare in the clinic and often overlooked. The objective of the current study is to analyze the clinical characteristics and prognosis of patients with MSDTC who underwent surgical treatment to determine the prognostic factors that affect survival. Methods: This study retrospectively analyzed the clinical data and postoperative follow-up results of MSDTC patients who underwent spinal surgery at the Orthopedic Department of Peking Union Medical College Hospital from January 2010 to January 2020. Clinical data and survival time were analyzed by Kaplan-Meier analysis. Results: Eleven patients were included, and the average age was 58.3 years (range 37-74). The average time from the initial surgery to the discovery of spinal metastasis was 42.9 months (range 0-132), and the average follow-up time was 21.8 months (range 3-80). Progression was identified in seven patients, and 10 patients (90.9%) died during the followup period. Kaplan-Meier analysis showed that extraosseous visceral metastasis (p=0.012), revised Tokuhashi score (p=0.035), Tomita score (p=0.038), and surgical method (p=0.028) were associated with overall survival (OS). In addition, skeletal visceral metastasis (p=0.017), revised Tokuhashi score (p=0.028), Tomita score (p=0.038), and surgical method (p=0.049) were associated with progression-free survival (PFS). Conclusion: Surgical treatment is an effective method for treating MSDTC and leads to pain relief, restored function and increased spinal stability. Based on our single-center experience, extraosseous visceral metastasis, revised Tokuhashi score, Tomita score, and surgical methods may be potential prognostic factors for OS whilst visceral metastasis, revised Tokuhashi score, Tomita score, and surgical methods may be potential prognostic factors for PFS.

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Spine Stereotactic Radiosurgery for Patients with Metastatic Thyroid Cancer: Secondary Analysis of Phase I/II Trials

Abstract: SSRS for thyroid metastases as a primary or adjuvant/salvage therapy is well tolerated and yields high rates of local control.

Cited by 35 publications

References 28 publications

Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution

Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution

An upper cervical cord compression secondary to occult follicular thyroid carcinoma metastases successfully treated with multiple radioiodine therapies

<p>A Single-Center, 10-Year Retrospective Study on Surgical Treatment and Prognosis Analysis of Differentiated Thyroid Carcinoma with Spinal Metastasis</p>

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