Distant bone metastases leading to the diagnosis of differentiated thyroid carcinoma: diagnostic challenge, management and outcomes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 429-448-Thyroid Neoplasia & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-433
Eva Feigerlova*, Seray Burcu Genc, Marc Klein, Lelia Groza, Laurent Brunaud and Georges Weryha
Centre Hospitalier Universitaire Nancy, Vandoeuvre, France
Context:  Distant metastases of differentiated thyroid cancer (DTC) are rare. Bone is the second most frequent metastatic site and metastatic disease detected at initial diagnosis confers a worse prognosis. There are only few reports regarding diagnostic circumstances, clinical work-up and outcomes of patients with DTC revealed by bone metastases.

Methods:We examined retrospectively the medical records of patients (n=13) admitted to our institution between 1985 and 2012 for DTC revealed by bone metastases.

Results:The median age at diagnostic was 62.2yr (range 43 - 78) with 54% females. Histology revealed follicular carcinoma in 69% and papillary in 31% patients. Eleven patients had bone metastases only, 2 had both lung and bone metastases. Mean number of bone metastatic sites was 2.2 + 1.3 DS. Five patients had a solitary bone metastasis. Pain was initial sign in 77% cases, concomitant with symptoms of spinal cord compression in 38% patients. All patients were initially treated with a total thyroidectomy and radioactive iodine (100mCi), with excision of metastasis (38%), and external radiotherapy (46%), followed by L-thyroxine treatment at suppressive doses and radioactive iodine until disappearance of metastatic uptake or a cumulative dose of 22 GBq. A median follow-up period was of 6.2yr: 62% patients were followed for a period between 5yr and 26yr, 38% for a period between 1yr and 5yr. Two patients died during the follow-up. Outcome was evaluated in 10 patients with a follow-up period longer than 2yr. Positive 18FDG-PET uptake detected in 5 patients was associated with a less favorable outcome and skeletal metastatic disease progression. In two youngest patients (< 50yr) disease stabilization was achieved. In refractory cases (n=7) zoledronate infusions reduced risk of bone events and pain and improved the quality of life.

Conclusion: DTC with bone metastases at the initial time of diagnosis worsens prognosis, but does not preclude a curative therapeutic approach, especially in young patients. The treatment must be active and adapted to each case. In refractory cases, the external radiotherapy, suppressive treatment and zoledronate infusions are important to improve the quality of life.

Nothing to Disclose: EF, SBG, MK, LG, LB, GW

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