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Stereotactic radiosurgery in the management of brain metastases from primary thyroid cancers

  • Clinical Study/Patient Study
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Abstract

Patients with metastatic well-differentiated thyroid cancer have a generally favorable long-term outcome although multi-organ involvement is a known marker of poor prognosis. Brain metastases are rare, occurring in less than 1% of patients with thyroid cancer. Few patients have been managed with stereotactic radiosurgery (SRS). A retrospective database of 5,067 patients treated for brain metastases between 1985 and 2007 was generated from 11 institutions. Thyroid cancer patients were identified in this database and, when possible, additional information was obtained from further chart review. Patients were excluded if they had incomplete treatment or follow-up information. Two validated prognostic indices, Graded prognostic Assessment (GPA) and Recursive Partitioning Analysis (RPA), were calculated for each patient. The overall survival times were calculated by the Kaplan–Meier method. Twenty-three thyroid cancer patients were identified (51% male, 48% female). Median age was 63 years (range 20–81). Pathology of the primary thyroid disease was available for twelve patients; the majority were diagnosed with differentiated thyroid cancer (n = 9 papillary, n = 2 Hürthle cell; 92%) and one had medullary subtype (8%). Median time from diagnosis of primary disease to brain metastasis was 41.8 months (range 0–516). Fifteen (65%) patients underwent SRS as part of their initial treatment with a median number of lesions treated of 1.5 (range 1–9). The median follow-up time for living patients was 35.2 months. Overall median survival time was 20.8 months (40% alive at last follow-up) and 37.4 months for SRS-treated patients (P = NS). A poor Karnofsky performance status was predictive of worse outcome (P = 0.001). GPA and RPA did not provide additional prognostic information. In conclusion, patients treated with SRS for brain metastases from primary thyroid cancer have a favorable prognosis with an expected median survival greater than 3 years. It is unclear as to whether current prognostic indices are relevant to this patient population.

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References

  1. Horner MJ, Reis LAG, Melbert D, krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (2004) SEER Cancer Statistics review 1975–2004. Available from: http://seer.cancer.gov/csr/1975_2006/. Accessed on August 16, 2009

  2. NCCN (2009) Thyroid carcinoma. National Comprehensive Cancer Network Guidelines 2009. Available from: www.nccn.org/professionals/physician. Accessed on August 16, 2009

  3. Hundahl SA, Fleming ID, Fremgen AM, Menck HR (1995) A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the United States, 1985–1995. Cancer 83:2638–2648

    Article  Google Scholar 

  4. Salvati M, Frati A, Rocchi G, Masciangelo R, Antonaci A, Gagliardi FM, Delfini R (2001) Single brain metastasis from thyroid cancer: report of twelve cases and review of literature. J Neurooncol 51:33–40

    Article  CAS  PubMed  Google Scholar 

  5. Hijiyiannakis P, Jefferies S, Harmer CL (1996) Brain metastases in patients with differentiated thyroid carcinoma. Clin Oncol 8:327–330

    Article  Google Scholar 

  6. Biswal BM, Bal CS, Sandhu MS, Padhy AK, Rath GK (1994) Management of intracranial metastases of differentiated carcinoma of thyroid. J Neurooncol 22:77–81

    Article  CAS  PubMed  Google Scholar 

  7. Chiu AC, Delpassand ES, Sherman SI (1997) Prognosis and treatment of brain metastases in thyroid carcinoma. J Clin Endocrinol Metab 82(11):3637–3642

    Article  CAS  PubMed  Google Scholar 

  8. Gaspar L, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47(1001–6):1001

    CAS  PubMed  Google Scholar 

  9. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic Index and comparison to three other indices for patients with brain metastases:an analysis of 1960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70(2):510–514

    PubMed  Google Scholar 

  10. Sperduto PW, Sneed P, Bhatt A, Schwer, Fiveash J, Chiang V, Knisely J, Zhu Y, Gaspar LE, Mehta M (2008) A multi-instituional validation study of a new prognostic index (graded prognostic assessment, GPA) for patients with brain metastases. Abstract in proceedings of the 50th annual astro meeting

  11. Neider C, Marienhagen K, Geinitz H, Molls M (2009) Validation of the graded prognostic assessment index for patients with brain metastases. Acta Oncol 48:457–459

    Article  Google Scholar 

  12. Gaspar L, Scott C, Murray K, Rottman M (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751

    CAS  PubMed  Google Scholar 

  13. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomized trial. Lancet 363:1665–1672

    Article  PubMed  Google Scholar 

  14. Sperduto PW, Chao S, Sneed PK, Luo X, Suh J, Roberge D, Bhatt A, Jensen AW, Brown PD, Shih H, Kirkpatrick J, Schwer A, Gaspar LE, Fiveash JB, Chiang V, Knisely J, Sperduto CM, Mehta M (2009) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 70(2):510–514

    Google Scholar 

  15. Sperduto PW, Chao S, Sneed PK, Luo X, Suh J, Roberge D, Bhatt A, Jensen AW, Shih H, Kirkpatrick J, Schwer A (2009) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of over 5,000 patients. Abstract in proceedings of the 51th annual astro meeting

  16. Kaplan EL, Meirer P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  17. McWilliams RR, Giannini C, Hay ID, Atkinson JL, Stafford SL, Buckner JC (2003) Management of brain metastases from thyroid carcinoma: a study of 16 pathologically confirmed cases over 25 years. Cancer 98:356–362

    Article  PubMed  Google Scholar 

  18. Kim IY, Kondziolka D, Niranjan A (2009) Gamma knife radiosurgery for metastatic brain tumors. J Neurooncol 93(3):355–359

    Article  PubMed  Google Scholar 

  19. Sherman SI, Wirth LJ, Droz JP, Hofmann M, Bastholt L, Martins RG, Licitra L, Eschenberg MJ, Sun YN, Juan T, Stepan DE, Schlumberger MJ, Motesanib Thyroid Cancer Study Group (2008) Motesanib diphosphate in progressive differentiated thyroid cancer. New Engl J Med 359(1):31–42

    Article  CAS  PubMed  Google Scholar 

  20. Lim S, Lee NY, Fury MG, Ghossein RA, Shaha AR, Wolden SL, Pfiser DG (2007) Doxorubicin and concurrent radiotherapy for anaplastic thyroid cancer: we need to do better. J Clin Oncol 25(18S):16506

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, McGill University Health Centre/Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada

    Daniel M. Bernad, Luis Souhami & David Roberge

  2. Gamma Knife Center, University of Minnesota, Minneapolis, MN, USA

    Paul W. Sperduto

  3. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Ashley W. Jensen

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  1. Daniel M. Bernad
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  2. Paul W. Sperduto
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  3. Luis Souhami
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  4. Ashley W. Jensen
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  5. David Roberge
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Correspondence to David Roberge.

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Bernad, D.M., Sperduto, P.W., Souhami, L. et al. Stereotactic radiosurgery in the management of brain metastases from primary thyroid cancers. J Neurooncol 98, 249–252 (2010). https://doi.org/10.1007/s11060-010-0175-z

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  • DOI: https://doi.org/10.1007/s11060-010-0175-z

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