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      Bone metastases from differentiated thyroid cancer: characteristics and prognostic factors in a multicenter series

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          Abstract

          Objective

          The aim of this study is to describe the characteristics, survival and prognostic factors of a cohort of patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC).

          Methods

          This was a multicenter retrospective observational study including patients diagnosed with BMs from DTC between 1980 and 2021. A Cox regression was performed to study prognostic factors for 5- and 10-year survival. Kaplan–Meier and log-rank tests were performed for the survival analysis and comparison between groups.

          Results

          Sixty-three patients were evaluated. Median follow-up from BM diagnosis was 35 (15–68) months. About 30 (48.4%) patients presented with synchronous BMs. Regarding histology, 38 (60.3%) had the papillary variant. BMs were multiple in 32 (50.8%) patients. The most frequent location was the spine (60.3%). Other metastases were present in 77.8%, mainly pulmonary (69.8%). Concerning treatment, 54 (85.9%) patients received I131, with BM uptake in 31 (49.2%) and 25 (39.7%) received treatment with multikinase inhibitors. Regarding complications, 34 (54%) patients had skeletal-related events, 34 (54%) died and 5- and 10-year overall survival was 42.4% and 20.4%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node involvement (hazard ratio (HR): 2.916; 95% confidence interval (CI): 1.013–8.391; P = 0.047) and treatment with I131 (HR 0.214 (95% CI 0.069–0.665); P = 0.008) at 5 years, the presence of other metastases (HR 6.844. 95% CI 1.017–46.05; P = 0.048) and treatment with I131 (HR 0.23 (95% CI 0.058–0.913); P = 0.037) at 10 years.

          Conclusions

          Our study reflects the management of patients with bone metastases from differentiated thyroid carcinoma in real clinical practice in several centers in southern Spain. Overall survival at 5 and 10 years was lower in patients who were not treated with I131, had nodal involvement and/or had other metastases.

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          Most cited references38

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          Lenvatinib versus placebo in radioiodine-refractory thyroid cancer.

          Martin Schlumberger, Makoto Tahara, Lori J Wirth … (2015)
          Lenvatinib, an oral inhibitor of vascular endothelial growth factor receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor α, RET, and KIT, showed clinical activity in a phase 2 study involving patients with differentiated thyroid cancer that was refractory to radioiodine (iodine-131).
          Article 0 comments Cited 456 times – based on 0 reviews     Review now
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            Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy.

            E Baudin, J D Lumbroso, N Haddy … (2006)
            The goal of this study was to estimate the cumulative activity of (131)I to be administered to patients with distant metastases from thyroid carcinoma. A total of 444 patients were treated from 1953-1994 for distant metastases from papillary and follicular thyroid carcinoma: 223 had lung metastases only, 115 had bone metastases only, 82 had both lung and bone metastases, and 24 had metastases at other sites. Treatment consisted of the administration of 3.7 GBq (100 mCi) (131)I after withdrawal of thyroid hormone treatment, every 3-9 months during the first 2 yr and then once a year until the disappearance of any metastatic uptake. Thyroxine treatment was given at suppressive doses between (131)I treatment courses. Negative imaging studies (negative total body (131)I scans and conventional radiographs) were attained in 43% of the 295 patients with (131)I uptake; more frequently in those who were younger, had well-differentiated tumors, and had a limited extent of disease. Most negative studies (96%) were obtained after the administration of 3.7-22 GBq (100-600 mCi). Almost half of negative studies were obtained more than 5 yr after the initiation of the treatment of metastases. Among patients who achieved a negative study, only 7% experienced a subsequent tumor recurrence. Overall survival at 10 yr after initiation of (131)I treatment was 92% in patients who achieved a negative study and 19% in those who did not. (131)I treatment is highly effective in younger patients with (131)I uptake and with small metastases. They should be treated until the disappearance of any uptake or until a cumulative activity of 22 GBq has been administered. In the other patients, other treatment modalities should be used when tumor progression has been documented.
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              Bone metastases

              Robert E Coleman, Peter I. Croucher, Anwar Padhani … (2020)
              Bone is the most frequent site for metastasis for many cancers, notably for tumours originating in the breast and the prostate. Tumour cells can escape from the primary tumour site and colonize the bone microenvironment. Within the bone, these disseminated tumour cells, as well as those arising in the context of multiple myeloma, may assume a state of dormancy, remaining quiescent for years before resuming proliferation and causing overt metastasis, which causes bone destruction via activation of osteoclast-mediated osteolysis. This structural damage can lead to considerable morbidity, including pain, fractures and impaired quality of life. Although treatment of bone metastases and myeloma bone disease is rarely curative, disease control is often possible for many years through the use of systemic anticancer treatments on a background of multidisciplinary supportive care. This care should include bone-targeted agents to inhibit tumour-associated osteolysis and prevent skeletal morbidity as well as use of appropriate local treatments such as radiation therapy, orthopaedic surgery and specialist palliative care to minimize the impact of metastatic bone disease on physical functioning. In this Primer, we provide an overview of the clinical features, the pathophysiology and the specific treatment approaches to prevent and treat bone metastases from solid tumours as well as myeloma bone disease.
              Article 0 comments Cited 198 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Thyroid J
                Journal ID (iso-abbrev): Eur Thyroid J
                Journal ID (publisher-id): ETJ
                Title: European Thyroid Journal
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Print): 2235-0640
                ISSN (Electronic): 2235-0802
                Publication date (Electronic): 26 July 2023
                Publication date (Electronic preprint): 26 July 2023
                Publication date Collection: 01 October 2023
                Volume: 12
                Issue: 5
                Electronic Location Identifier: e230086
                Affiliations
                [1 ]UGC Endocrinología y Nutrición , Hospital Universitario Virgen del Rocío, Sevilla, España
                [2 ]Servicio de Endocrinología , Hospital Universitario Reina Sofía, Córdoba, España
                [3 ]Servicio de Endocrinología , Hospital Universitario Virgen Macarena, Sevilla, España
                [4 ]Servicio de Endocrinología , Hospital Universitario Virgen de la Victoria, Málaga, España
                [5 ]Servicio de Endocrinología , Hospital Universitario Virgen de Valme, Sevilla, España
                Author notes
                Correspondence should be addressed to A Piñar-Gutiérrez: anapinarg@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-7834-1145
                Article
                Publisher ID: ETJ-23-0086
                DOI: 10.1530/ETJ-23-0086
                PMC ID: 10448562
                PubMed ID: 37493475
                SO-VID: 68e90578-71dd-4312-b4da-da190853eb4a
                Copyright © © the author(s)
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Date received : 24 April 2023
                Date accepted : 26 July 2023
                Categories
                Subject: Research

                Keywords: thyroid cancer,bone metastases,survival,skeletal-related events,radioiodine,multikinase inhibitors,antiresorptive agents
                Data availability:
                Keywords: thyroid cancer, bone metastases, survival, skeletal-related events, radioiodine, multikinase inhibitors, antiresorptive agents

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