ECE2017 Guided Posters Thyroid Cancer (11 abstracts)
Management and outcome of bone metastasis from differentiated thyroid carcinoma in the real life: the M.OS.CA.TI. study
Gherardo Mazziotti 1 , Maria Beatrice Panarotto 2, , Emanuela Arvat 5 , Arturo Chiti 6 , Alberto Cuocolo 7 , Massimo Dottorini 8 , Rossella Elisei 10 , Sebastiano Filetti 9 , Angelina Filice 11 , Anna Maria Formenti 2, , Leonardo Pace 13 , Teresa Pellegrino 14 , Marcello Nodari 6 , Massimo Salvatori 15 , Cristina Tranfaglia 8 , Annibale Versari 11 , Stefano Frara 16 , Alfredo Berruti 4 , Andrea Giustina 16 & Raffaele Giubbini 2,
1Endocrine Unit, ASST Carlo Poma, Mantua, Italy; 2Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy; 3Nuclear Medicine, University of Brescia, Brescia, Italy; 4Clinical Oncology, University of Brescia, Brescia, Italy; 5Oncological Endocrinology, University of Turin, Turin, Italy; 6Nuclear Medicine, Humanitas, Milan, Italy; 7Nuclear Medicine, University Federico II of Naples, Naples, Italy; 8Nuclear Medicine, “Maria della Misericordia” Hospital, Perugia, Italy; 9Internal Medicine, University Sapienza of Rome, Rome, Italy; 10Endocrinology, University of Pisa, Pisa, Italy; 11Nuclear Medicine, Arcispedale S. Maria Nuova A.O. Reggio Emilia, Reggio Emilia, Italy; 12Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; 13Department of Medicine and Surgery, University of Salerno, Salerno, Italy; 14Institute of Biostructure and Bioimaging of the National Research Council of Italy – CNR, Naples, Italy; 15Nuclear Medicine, Catholic University of Rome, Italy, Rome, Italy; 16Endocrinology, San Raffaele Vita-Salute University, Milan, Italy.
Although differentiated thyroid cancer (DTC) has the third highest propensity to spread to the bone after breast and prostate cancer, there is a paucity of data concerning the treatment of bone metastasis (BM) in this setting. The MOSCATI (Metastasi OSsee da Carcinoma TIroideo) was a multicenter, retrospective study investigating the real-life outcome and management of BM in 143 patients (80 F, 63 M; median age 60 years) with DTC involving 10 specialized centers in Italy. One or more skeletal related events (SREs) were diagnosed in 58% of patients in significant association with more aggressive tumor histotype (OR 5.39), higher number of BM (OR 1.36), localization of BM to thoracic spine (OR 2.7), cervical spine (OR 7.47) or skull (OR 2.28), and lack of radio-iodine (RAI) uptake (OR 6.03). RAI treatment was performed in 93% of patients. Bone active drugs were used in 32 patients with SRE (22.4%; zoledronate in 31 and denosumab in one). Bone active drugs were used more frequently in patients with more aggressive histotype of DTC (P<0.001), with RAI-refractory BM (P<0.001) who did not receive RAI therapy (P<0.001) and/or in those with multiple BM (P=0.006), malignant hypercalcemia (P=0.001), pathological fractures (P=0.02) and in those undergoing radiotherapy (P<0.001). After treatment, 13.5% of patients developed new SREs and 39 patients (27.3%) died. RAI treatment significantly prevented the second SRE (HR 0.01) and decreased mortality (HR 0.12) as compared to patients treated with anti-resorptive drugs alone. Patients treated with RAI plus anti-resoptive drugs showed less efficacy in preventing second SRE and decreasing mortality as compared to treatment with RAI alone. In conclusion, in the real life, the use of bone active drugs is currently limited to zoledronate in patients with pre-existing SREs. In this specific clinical setting, RAI therapy, but not zoledronate, prevented progression of SREs and mortality. Future studies are needed to clarify the effectiveness of anti-resorptive drugs in primary prevention of SREs and possible advantages of denosumab versus zoledronate in the treatment of BM from DTC.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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