Treatment Outcomes of External Beam Radiation Therapy for Unresectable Locally Advanced Thyroid Cancer with or without Metastasis: A Retrospective Single-Center Study

Abstract

We evaluated treatment outcomes of external beam radiation therapy (EBRT) for unresectable locally advanced thyroid cancer (LATC) with or without metastasis. We enrolled 11 LATC patients who underwent EBRT (median age: 76 (45–83) years; six males and five females). Eastern Cooperative Oncology Group performance statuses of 0 (n = 3), 1 (n = 1), 2 (n = 6), and 3 (n = 1) were observed. Histologic types included papillary carcinoma (n = 5), anaplastic carcinoma (n = 3), and squamous cell carcinoma (n = 3). The organs invaded by the tumor that caused it to be deemed unresectable were common carotid artery (n = 5), trachea (n = 4), aorta (n = 1) and larynx (n = 1). The median follow-up time was 6 months. One, seven, two, and one patient showed complete response (CR), partial response (PR), stable disease, and progressive disease, respectively. The rate of local CR+PR was 73%; moreover, 75% of patients achieved a >30% tumor size reduction within 6 months. The median local progression-free survival of patients with local CR+PR was 11.5 (4–68) months. The median overall survival was 6 (1–68) months. Grade 3 acute complications occurred in five (45%) patients. No patients had Grade 4 or 5 complications. In conclusion, EBRT reduced the tumor volume in 75% of LATC patients without inducing severe toxicity. This therapy should be considered as a treatment option for LATC.

Thoracic Spinal Metastasis With Hip Flexion Failure and Psoas Muscle Atrophy Successfully Improved With Radiotherapy: A Case Report

“…MPS typically arises from distant metastasis or direct infiltration of the psoas muscle by malignancy. MPS manifests as neuropathic pain in the lumbosacral plexus region, primarily occurring during hip extension [2][3][4][5][6][7][8][9][10][11]. While MPS is commonly associated with lumbosacral plexopathy, more cases of lumbosacral plexopathy occurring in the lower lumbar spine have been reported [13].…”

“…MPS, including lumbosacral plexopathy, leads to gait disturbances associated with hip flexion despite the absence of direct involvement of lower extremity muscles and nerves [11]. Unfortunately, despite its characteristic presentation, MPS is frequently overlooked in clinical practice, and diagnosis can be challenging due to the absence of a well-defined symptom set [3,11]. In the present case, it was difficult to link the symptom of hip flexion difficulty with the malignancy until palliative irradiation was requested, and confirmation of the diagnosis was thus delayed.…”

“…Malignant psoas syndrome (MPS) is a condition in which a malignant tumor metastasizes to or invades the psoas muscle, leading to symptoms such as severe pain and painful restriction of hip joint mobility [1]. MPS syndrome is an occasionally encountered disease that has been documented in several case reports and case series reports since its initial description in 1990 [2][3][4][5][6][7][8][9][10]. Recently, MPS has received increased attention with the publication of review articles and retrospective studies on treatment outcomes [3,11].…”

“…MPS syndrome is an occasionally encountered disease that has been documented in several case reports and case series reports since its initial description in 1990 [2][3][4][5][6][7][8][9][10]. Recently, MPS has received increased attention with the publication of review articles and retrospective studies on treatment outcomes [3,11]. Since the psoas muscle is responsible for hip flexion, the quality of life (QOL) of cancer patients in the terminal stage may significantly deteriorate due to pain resulting from tumor infiltration into the psoas muscle along with impaired gait caused by limited hip movement [3,11].…”

“…Recently, MPS has received increased attention with the publication of review articles and retrospective studies on treatment outcomes [3,11]. Since the psoas muscle is responsible for hip flexion, the quality of life (QOL) of cancer patients in the terminal stage may significantly deteriorate due to pain resulting from tumor infiltration into the psoas muscle along with impaired gait caused by limited hip movement [3,11]. Previous reports have highlighted cases that deviate from the typical presentation, including cases in which the characteristic painful fixation of the hip joint is not observed and cases with atypical symptoms [12].…”