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

G. Mazziotti, A. M. Formenti, M. B. Panarotto, E. Arvat, A. Chiti, A. Cuocolo, M. E. Dottorini, C. Durante, L. Agate, S. Filetti, F. Felicetti, A. Filice, L. Pace, T. Pellegrino, M. Rodari, M. Salvatori, C. Tranfaglia, A. Versari, D. Viola, S. FraraA. Berruti, A. Giustina, R. Giubbini

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalEndocrine
DOIs
Publication statusAccepted/In press - Nov 6 2017

Keywords

  • Bone metastases
  • Denosumab-radioiodine
  • Thyroid carcinoma
  • Zoledronate

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    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., ... Giubbini, R. (Accepted/In press). Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience. Endocrine, 1-12. https://doi.org/10.1007/s12020-017-1455-6