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)90-101
Number of pages12
JournalEndocrine
Volume59
Issue number1
DOIs
Publication statusPublished - Jan 2018

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Thyroid Neoplasms
zoledronic acid
Neoplasm Metastasis
Bone and Bones
Radio
Iodine
Pharmaceutical Preparations
Radiotherapy
Spontaneous Fractures
Spinal Cord Compression
Mortality
Hypercalcemia
Therapeutics
Skeleton
Multicenter Studies
Hip
Spine
Retrospective Studies
Survival

Keywords

  • Journal Article

Cite this

Real-life management and outcome of thyroid carcinoma-related bone metastases : results from a nationwide multicenter experience. / 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; Berruti, A; Giustina, A; Giubbini, R.

In: Endocrine, Vol. 59, No. 1, 01.2018, p. 90-101.

Research output: Contribution to journalArticle

Mazziotti, G, Formenti, AM, Panarotto, MB, Arvat, E, Chiti, A, Cuocolo, A, Dottorini, ME, 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, Berruti, A, Giustina, A & Giubbini, R 2018, 'Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience', Endocrine, vol. 59, no. 1, pp. 90-101. https://doi.org/10.1007/s12020-017-1455-6
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 ; Berruti, A ; Giustina, A ; Giubbini, R. / Real-life management and outcome of thyroid carcinoma-related bone metastases : results from a nationwide multicenter experience. In: Endocrine. 2018 ; Vol. 59, No. 1. pp. 90-101.
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T1 - Real-life management and outcome of thyroid carcinoma-related bone metastases

T2 - results from a nationwide multicenter experience

AU - Mazziotti, G

AU - Formenti, A M

AU - Panarotto, M B

AU - Arvat, E

AU - Chiti, A

AU - Cuocolo, A

AU - Dottorini, M E

AU - Durante, C

AU - Agate, L

AU - Filetti, S

AU - Felicetti, F

AU - Filice, A

AU - Pace, L

AU - Pellegrino, T

AU - Rodari, M

AU - Salvatori, M

AU - Tranfaglia, C

AU - Versari, A

AU - Viola, D

AU - Frara, S

AU - Berruti, A

AU - Giustina, A

AU - Giubbini, R

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1007/s12020-017-1455-6

DO - 10.1007/s12020-017-1455-6

M3 - Article

C2 - 29110129

VL - 59

SP - 90

EP - 101

JO - Endocrine

JF - Endocrine

SN - 1355-008X

IS - 1

ER -