Surgical management of follicular carcinoma of thyroid with spinal metastasis

Authors

  • Anil Chander Department of Orthopedics, Sri Ramachandra University, Chennai
  • Vignesh Jayabalan Department of Orthopedics, Sri Ramachandra University, Chennai
  • Ganesan Ram Ganesan Department of Orthopedics, Sri Ramachandra University, Chennai
  • Gauthaman Shanmugasundaram Department of Surgical Oncology, Sri Ramachandra University, Chennai
  • Karthik Kailash Kannan Department of Orthopedics, Sri Ramachandra University, Chennai

DOI:

https://doi.org/10.18203/2349-2902.isj20151086

Keywords:

Spinal metastasis, Thyroid carcinoma, Tokuhashi score, Radioiodine

Abstract

Background:Spine is the most common part of bone metastasis of follicular carcinoma and is primarily osteolytic. The primary concern with metastasis is pathologic fracture and/or spinal cord compression, which may lead to intractable pain, sensory alterations, weakness, and/or paralysis. Management is curative or palliative and includes surgery, radioiodine ablation, selective embolization, medical management. In this study, we present a retrospective analysis of five patients with follicular carcinoma of thyroid with spinal metastasis treated surgically.

Methods: With the approval of the institutional review board, we retrospectively analyzed all the patients who underwent surgery for follicular carcinoma of thyroid with spinal metastasis from Jan 2011 to Jan 2015 at Sri Ramachandra Medical Centre. Patients were considered for spine surgery, when they had severe pain and/or neurological deficit, spinal instability and Tokuhashi score of at least 9. Total of 5 patients with follicular carcinoma underwent spinal surgery.

Results:Three patients had improvement in KPS scores; one had no change and remaining one had lower KPS score at final follow up. Four out of the five patients (80%) had improvement in VAS pain scores.

Conclusions:Even though there are no established regimens in treating spinal metastasis from follicular carcinoma of thyroid and very few reports published in this regard, curative/palliative spine surgery along with radioiodine ablation gives short to midterm remission and clinical improvement in this patient group.

References

Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type. Thyroid. 2011;21:125-34.

Kilfoy BA. International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control. 2009;20:525-31.

Rodrigues G, Ghosh A. Synchronous bony and soft tissue metastases from follicular carcinoma of the thyroid. J Korean Med Sci. 2003;18: 914-6.

Muresan MM. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008;15:37-49.

Tickoo SK. Bone metastases from thyroid carcinoma: a histopathologic study with clinical correlates. Arch Pathol Lab Med. 2000;124:1440-7.

Harrington KD. Metastatic disease of the spine. J Bone Joint Surg Am. 1986;68:1110-5.

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. 2001;26:298-306.

Van Tol KM. Embolization in combination with radioiodine therapy for bone metastases from differentiated thyroid carcinoma. Clin Endocrinol. 2000;52:653-9.

Mercadante S, Fulfaro F. Management of painful bone metastases. Curr Opin Oncol. 2007;19:308-14.

Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(19):2186-91.

Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. JCO. 1984;2(3):187-93.

Pittas AG. Bone metastases from thyroid carcinoma: clinical characteristics and prognostic variables in one hundred forty-six patients. Thyroid. 2000;10:261-8.

Quan GM, Pointillart V, Palussière J, Bonichon F. Multidisciplinary treatment and survival of patients with vertebral metastases from thyroid carcinoma. Thyroid. 2012;22:125-30.

Hosono N, Ueda T, Tamura D, Aoki Y, Yoshikawa H. Prognostic relevance of clinical symptoms in patients with spinal metastases. Clin Orthop Relat Res. 2005:195-201.

Baudin E, Schlumberger M. New therapeutic approaches for metastatic thyroid carcinoma. Lancet Oncol. 2007;8:148-56.

Wexler JA: Approach to the Thyroid Cancer Patient with Bone Metastases. J Clin Endocrinol Metab. 2011;96:2296-307.

Van Tol KM. Embolization in combination with radioiodine therapy for bone metastases from differentiated thyroid carcinoma. Clin Endocrinol. 2000;52:653-9.

Hindie E. Bone metastases of differentiated thyroid cancer: Impact of early I-131-based detection on outcome. Endocr Relat Cancer. 2007;14:799-807.

Eustatia-Rutten CF. Outcome of palliative embolization of bone metastases in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:3184-9.

De Vries MM. Embolization therapy of bone metastases from epithelial thyroid carcinoma: effect on symptoms and serum thyroglobulin. Thyroid. 2008;18:1277-84.

Sayama CM, Schmidt MH, Bisson EF. Cervical spine metastases: techniques for anterior reconstruction and stabilization. Neurosurg Rev. 2012;35(4):463-74.

Demura S. Total en bloc spondylectomy for spinal metastases in thyroid carcinoma. J Neurosurg Spine. 2011;14:172-6.

Cotten A, Dewatre F, Cortet B. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200:525-30.

Dunn J. Percutaneous vertebroplasty in the management of a patient with malignant pain and associated osteolytic compression fractures. Curr Pain Headache Rep. 2002;6:436-43.

Fourney DR, Schomer DF, Nader R. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg Spine. 2003;98:21-30.

Goldstein SI, Kaufman D, Abati AD. Metastatic thyroid carcinoma presenting as distal spinal cord compression. Ann Otal Rhinol Laryngol. 1998;97:393-6.

Shaha AR, Shah JP, Loree TR. Differantiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174:474-6.

Downloads

Published

2016-12-14

Issue

Section

Original Research Articles