Abstract
Simple SummaryPatients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC) can live longer than those with BMs from other cancers. BMs from DTC create destructive lesions and easily cause intractable pain and neurological symptoms, including paralysis. These symptoms related to BMs affect mortality directly and indirectly by hampering the application of systemic therapies. Therefore, long-term local control of BMs in patients with DTC is desired, especially in patients with single or a small number of metastases. Local treatments for BMs have recently become advanced and sophisticated in surgery, radiotherapy, and percutaneous procedures. These therapies, either alone or in combination with other treatments, can effectively improve, or prevent the deterioration of, the performance status and quality of life of patients with DTC-BM. Among local therapies, complete surgical resection and stereotactic radiosurgery are the mainstay for achieving long-term control of DTC-BM.After the lung, the skeleton is the second most common site of distant metastases in differentiated thyroid carcinoma (DTC). Patients with osteolytic bone metastases (BMs) from thyroid carcinoma often have significantly reduced performance status and quality of life. Recent advancements in cancer therapy have improved overall survival in multiple cancer subtypes, including thyroid cancer. Therefore, long-term local control of thyroid BMs is desired, especially in patients with a single metastasis or oligometastases. Here, we reviewed the current management options for DTC-BMs and especially focused on local treatments for long-term local tumor control from an orthopedic tumor surgeon’s point of view. Metastasectomy and stereotactic radiosurgery can be performed either alone or in combination with radioiodine therapy and kinase inhibitors to cure skeletal lesions in selected patients. Percutaneous procedures have been developed in recent years, and they can also have a curative role in small BMs. Recent advancements in local therapies have the potential to provide not only long-term local tumor control but also a better prognosis.
Highlights
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy [1].The prognosis of DTC is generally favorable, with a 10-year survival rate of over 95% [2,3].in 5% to 25% of patients, distant metastases are detected at the time of diagnosis or during the disease’s course
In cases of bone metastases (BMs), several studies have reported a worse response to treatment and a shorter progression-free survival (PFS) rate among patients treated with sorafenib and sunitinib [25,26,27,28]
A prospective study showed that the absence of BM independently predicted superior PFS and overall survival (OS) in patients with radioactive iodine (RAI)-refractory DTC who were treated with sorafenib [29]
Summary
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy [1]. The prognosis of DTC is generally favorable, with a 10-year survival rate of over 95% [2,3]. In patients with DTC, the bone is the second most common site for distant metastases after the lung [2,4]. The prognosis of patients with BM from DTC is still favorable, with a 10-year overall survival (OS) rate of. 35% to 47% [10,11], compared with that of patients with BM from other cancers Despite this relatively favorable prognosis, patients with osteolytic BMs from DTC often have a significantly reduced performance status (PS) and quality of life (QOL), with intractable pain, neurological symptoms, and increased mortality [12,13,14]. Long-term local control of thyroid BMs is desired, especially in patients with a single metastasis or oligometastases, who are expected to live longer. We reviewed the current management options for DTC-BMs and especially focused on local treatment for long-term local tumor control, including surgical metastasectomy, from the orthopedic tumor surgeon’s point of view
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