Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience.

Autor: Mazziotti, G., Formenti, A. M., Panarotto, M. B., Arvat, E., Chiti, A., Cuocolo, A., Dottorini, M. E., Durante, C., Agate, L., Filetti, S., Felicetti, F., Filice, A., Pace, L., Pellegrino, T., Rodari, M., Salvatori, M., Tranfaglia, C., Versari, A., Viola, D., Frara, S.
Zdroj: Endocrine (1355008X); Jan2018, Vol. 59 Issue 1, p90-101, 12p
Abstrakt: Purpose and Patients: The M.O.S.CA.TI. (Metastases of the Skeleton from CArcinoma of the ThyroId) is a multicenter, retrospective study investigating the real-life outcome and management of bone metastases (BM) in 143 patients (63 M, 80 F; median age 64 years, range 11-87) with differentiated thyroid carcinoma (DTC). Results: Radio-active iodine (RAI) treatment was performed in 131 patients (91.6%), surgical approach and/or external radiotherapy in 68 patients (47.6%), and anti-resorptive bone-active drugs in 32 patients (22.4%; in 31 zoledronate and in one denosumab). At the start of treatment, 24 patients (75.0%) receiving anti-resorptive bone-active drugs had at least one clinical skeletal-related event (SRE) ( p < 0.001). One or more clinical SREs (pathological fractures and/or malignant hypercalcemia and/or spinal cord compression) developed in 53 patients (37.1%). Development of SREs was significantly associated with metachronous BM (hazard ratio (HR) 2.04; p = 0.04), localization of BM to cervical spine (HR 3.89; p = 0.01), and lack of avid RAI uptake (HR 2.66; p = 0.02). Thirty-nine patients (27.3%) died in correlation with development of SREs (HR 6.97; p = 0.006) and localization of BM to the hip (HR 3.86; p = 0.02). Moreover, overall mortality was significantly decreased by RAI therapy (HR 0.10; p = 0.02), whereas no significant effects were induced by bone-active drugs ( p = 0.36), external radiotherapy ( p = 0.54), and surgery ( p = 0.43) of BM. Conclusions: SREs are very frequent in BM from DTC and they impact patient survival. In the real life, the use of bone-active drugs is currently limited to zoledronate in patients with pre-existing SREs. In this clinical setting, RAI therapy, but not zoledronate, decreased mortality. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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