Thyroid Cancer Brain Metastasis

Osborne, Joseph R.; Kondraciuk, Jessica D.; Rice, Samuel L.; Zhou, Xiaosun; Knežević, Andrea; Spratt, Daniel E.; Sabra, Mona M.; Larson, Steven M.; Grewal, Ravinder K.

doi:10.1097/rlu.0000000000002618

Cited by 17 publications

(8 citation statements)

References 23 publications

(30 reference statements)

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“…This again supports open surgery as the treatment of choice for BM, even in patients with impaired general condition [ 8 ]. While SRS could also be shown as effective in our series in line with literature reports [ 20 , 32 ], we and several authors found resection to be an independent covariate for prolonged survival [ 4 , 30 , 33 , 34 , 36 ]. In analogy to other series, our analysis does not allow for estimation of RAI therapy as a therapeutic option for BM, which has only been anecdotally reported in the literature [ 35 ].…”

Section: Discussionsupporting

confidence: 91%

Clinical characteristics, treatment, and long-term outcome of patients with brain metastases from thyroid cancer

Wolff

Steindl

Popov

et al. 2023

Clin Exp Metastasis

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Brain metastases (BM) in patients with thyroid cancer (TC) are rare with an incidence of 1% for papillary and follicular, 3% for medullary and up to 10% for anaplastic TC (PTC, FTC, MTC and ATC). Little is known about the characteristics and management of BM from TC. Thus, we retrospectively analyzed patients with histologically verified TC and radiologically verified BM identified from the Vienna Brain Metastasis Registry. A total of 20/6074 patients included in the database since 1986 had BM from TC and 13/20 were female. Ten patients had FTC, 8 PTC, one MTC and one ATC. The median age at diagnosis of BM was 68 years. All but one had symptomatic BM and 13/20 patients had a singular BM. Synchronous BM at primary diagnosis were found in 6 patients, while the median time to BM diagnosis was 13 years for PTC (range 1.9–24), 4 years for FTC (range 2.1–41) and 22 years for the MTC patient. The overall survival from diagnosis of BM was 13 months for PTC (range 1.8–57), 26 months for FTC (range 3.9–188), 12 years for the MTC and 3 months for the ATC patient. In conclusion, development of BM from TC is exceedingly rare and the most common presentation is a symptomatic single lesion. While BM generally constitute a poor prognostic factor, individual patients experience long-term survival following local therapy.

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Section: Discussionsupporting

confidence: 91%

Clinical characteristics, treatment, and long-term outcome of patients with brain metastases from thyroid cancer

Wolff

Steindl

Popov

et al. 2023

Clin Exp Metastasis

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“…Tumor cells harboring specific genetic alterations can drive differential clinical outcomes. The TERT gene mutation was frequently observed in thyroid cancer brain metastases [ 51 ]. Additionally, BRAF mutations have been linked to the increased risk of brain metastasis at first diagnosis in such tumors [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Site-Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi-Organ Disease

Toraih

Hussein

Zerfaoui

et al. 2021

Cancers

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Introduction—heterogeneity in clinical outcomes and survival was observed in patients with papillary thyroid cancer (PTC) and distant metastases. Here, we investigated the effect of distant metastases sites on survival in PTC patients. Methods—patients with a diagnosis of PTC and known metastases were identified using the Surveillance, Epidemiology, and End Results database (1975–2016). Univariate and multivariate Cox regression analyses were performed to analyze the effect of distant metastases sites on thyroid cancer-specific survival (TCSS) and overall survival (OS). Results—from 89,694 PTC patients, 1819 (2%) developed distant metastasis at the initial diagnosis, of whom 26.3% presented with the multiple-organ disease. The most common metastatic sites were lung (53.4%), followed by bone (28.1%), liver (8.3%), and brain (4.7%). In metastatic patients, thyroid cancer-specific death accounted for 73.2%. Kaplan–Meier curves showed decreased OS in patients with metastases to the brain (median OS = 5 months) and liver (median OS = 6 months) compared to lung (median OS = 10 months) and bone (median OS = 23 months). Moreover, multiple organ metastasis had a higher mortality rate (67.4%) compared to single organ metastasis (51.2%, p < 0.001). Using multivariate analysis, risk factors that significantly influence TCSS and OS were male gender (HR = 1.86, 95% CI = 1.17–2.94, p < 0.001, and HR = 1.90, 95% CI = 1.40–2.57, p = 0.009), higher tumor grade (HR = 7.31, 95% CI = 2.13–25.0, p < 0.001 and HR = 4.76, 95% CI = 3.93–5.76, p < 0.001), multiple organ involvement (HR = 6.52, 95% CI = 1.50–28.39, p = 0.026 and HR = 5.08, 95% CI = 1.21–21.30, p = 0.013), and brain metastasis (HR = 1.82, 95% CI = 1.15–2.89, p < 0.001 and HR = 4.21, 95% CI = 2.20–8.07, p = 0.010). Conclusion—the pattern of distant metastatic organ involvement was associated with variability in OS in PTC. Multi-organ metastasis and brain involvement are associated with lower survival rates in PTC. Knowledge of the patterns of distant metastasis is crucial to personalize the treatment and follow-up strategies.

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“…Je nach individueller Situation können isolierte Metastasen auch durch lokale Therapien behandelt werden. Diese kann beispielsweise in Form einer Resektion [15] oder perkutanen Radiotherapie einer pulmonalen Metastase [14], einer Radiotherapie [16], Resektion [17] oder seltener einer arteriellen Embolisation [18] einer solitären Knochenmetastase, einer Radiotherapie einer Hirnmetastase [19] oder eines zervikalen regionalen Rezidivs sowie einer Radiofrequenzablation einer hepatischen Metastase [20] Wann wird die medikamentöse Tumortherapie eingesetzt?…”

Section: Radiojodrefraktäritätwie Geht Es Weiter?unclassified

Behandlungsstrategie beim radiojodrefraktären differenzierten Schilddrüsenkarzinom

Mantsopoulos

Mueller

Pavel

et al. 2023

TumorDiagnostik & Therapie

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ZusammenfassungTraditionell besteht das multimodale Therapiekonzept bei den differenzierten Schilddrüsenkarzinomen in der Thyreoidektomie mit Neck-Dissection (bei cN+-Halsstatus) und adjuvanten Radiojodablation mit abschließender risikoadaptierter TSH-Suppression. Das Ausmaß der Radiojodaufnahme beim metastasierten Schilddrüsenkarzinom spielt eine signifikante Rolle bei der Einschätzung der Prognose. Das fehlende Jodspeicherungsvermögen einer Läsion in Zusammenschau mit dem fehlenden Abfall des Tumormarkers Thyreoglobulin sowie radiologische Zeichen einer Tumorprogression charakterisieren den Radiojod-refraktären Patienten. Aufgrund des meistens über einen langen Zeitraum indolenten Verlaufs erscheint in den meisten Fällen ein abwartendes Verhalten in Kombination mit lokaler Metastasenbehandlung sowie Symptomlinderung primär sinnvoll zu sein. Der Nachweis einer Veränderung der Tumordynamik ist der Zeitpunkt, um eine Systemtherapie zu evaluieren. Diese beruht auf Multi-Tyrosinkinase-Inhibitoren (Sorafenib, Lenvatinib). Diese Substanzen sind größtenteils mit einem ungünstigen Nebenwirkungsprofil assoziiert (Diarrhö, Hautauschläge, arterielle Hypertonie mit hypertensiver Entgleisung, lokale Wundheilungsstörungen), welches zu einer nicht vernachlässigbaren Rate einer therapieassoziierten Morbidität sowie einer hohen Anzahl an Therapieunterbrechungen führt. Daher sind im Jahr 2020 2 selektive RET-Inhibitoren (Selpercatinib, Pralsetinib) für die differenzierten Schilddrüsenkarzinome von der FDA zugelassen worden. Eine neue Perspektive für die Zukunft wären die unterschiedlichen Redifferenzierungsstrategien, welche auf die Steigerung der Sensitivität der Tumorzellen auf Radiojod abzielen.

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Thyroid Cancer Brain Metastasis

Cited by 17 publications

References 23 publications

Clinical characteristics, treatment, and long-term outcome of patients with brain metastases from thyroid cancer

Clinical characteristics, treatment, and long-term outcome of patients with brain metastases from thyroid cancer

Site-Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi-Organ Disease

Behandlungsstrategie beim radiojodrefraktären differenzierten Schilddrüsenkarzinom

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