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LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 4  |  Page : 656-657

Advantages of surgical extirpation in addition to radioiodine therapy in differentiated thyroid carcinoma patients with a solitary large-volume skeletal metastasis with small-volume oligometastatic disease in the rest of the whole body


Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Jerbai Wadia Road, Parel, Mumbai, India

Date of Web Publication29-Jan-2013

Correspondence Address:
Sandip Basu
Radiation Medicine Centre (B.A.R.C), T.M.C Annexe, Jerbai Wadia Road, Parel, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.106595

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How to cite this article:
Basu S, Borde CR, Abhyankar A. Advantages of surgical extirpation in addition to radioiodine therapy in differentiated thyroid carcinoma patients with a solitary large-volume skeletal metastasis with small-volume oligometastatic disease in the rest of the whole body. J Can Res Ther 2012;8:656-7

How to cite this URL:
Basu S, Borde CR, Abhyankar A. Advantages of surgical extirpation in addition to radioiodine therapy in differentiated thyroid carcinoma patients with a solitary large-volume skeletal metastasis with small-volume oligometastatic disease in the rest of the whole body. J Can Res Ther [serial online] 2012 [cited 2019 Dec 10];8:656-7. Available from: http://www.cancerjournal.net/text.asp?2012/8/4/656/106595

Sir,

Surgical resection is proposed to be a useful approach to radioiodine therapy in the differentiated thyroid carcinoma patients with an isolated solitary large bone metastasis. We herein report excellent disease control and better quality of life in a 58-year-old male with large sternal and right clavicular metastases as well as small volume hepatic and pelvic bone metastases [Figure 1]. After three consecutive sessions of I-131 therapy (cumulative dose of 25,456 MBq), he was considered for surgery in view of persistent large sternal swelling with compressive symptoms in the patient. He subsequently underwent surgical excision of the sternal and clavicular metastases. The serum thyroglobulin (Tg) level had been reduced from 353 ng/ml to 27 ng/ml 6 months following surgery. He is presently 7 years after initial diagnosis (3 years following surgery), with significantly better quality of life and a stable disease in the scan.
Figure 1: Postradioiodine therapy scan prior to the surgery demonstrated intense I-131 concentration in the sternum and right clavicle. In addition, there was small volume disease in the liver and right side of the pelvic bone (right sacroiliac joint region as noted in the bone scan)

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Published literature has documented evidence of improved outcome when surgical resection is added to the conventional approach to radioiodine therapy in patients of differentiated thyroid carcinoma with an isolated solitary large bone metastasis. [1],[2],[3],[4],[5] In our case, better quality of life following excision was a demonstrable effect due to reduction of the compressive symptoms arising from the large volume sternal disease. In the subsequent follow-up, the Tg value was reduced substantially compared to the presurgery values and the disease had been stable. He was treated with another dose of 9102 MBq I-131 and the posttherapy scan [Figure 2] at this time (i.e., 3 years following surgery) demonstrated stable disease with small volume lesion in the liver and right pelvis as observed previously.
Figure 2: Postradioiodine therapy scan undertaken 3 years following the surgery demonstrated stable disease with small I-131 avid lesions in the liver and right side of the pelvis as observed previously

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There have been multiple unresolved issues that have been highlighted in a recent report on this subject. [5] The optimum timing of surgery in such a case is yet to be defined. As observed in this case, it is likely that the indication of this approach may not be restricted only to solitary metastatic disease but it may be also extended to small volume oligometastatic disease at other sites. Finally whether this improves the overall survival in these patients is a fact that has to be determined in future studies.

 
 > References Top

1.Mishra A, Mishra SK, Agarwal A, Agarwal G, Agarwal SK. Surgical treatment of sternal metastases from thyroid carcinoma: Report of two cases. Surg Today 2001;31:799-802.  Back to cited text no. 1
    
2.Lequaglie C, Massone PP, Giudice G, Conti B. Analysis and long-term survival in sternectomy with plastic reconstruction for primary and secondary neoplasms of the sternum. Chir Ital 2001;53:485-94.  Back to cited text no. 2
    
3.Zettinig G, Fueger BJ, Passler C, Kaserer K, Pirich C, Dudczak R, et al. Long-term follow-up of patients with bone metastases from differentiated thyroid carcinoma - surgery or conventional therapy? Clin Endocrinol (Oxf) 2002;56:377-82.  Back to cited text no. 3
    
4.Niederle B, Roka R, Schemper M, Fritsch A, Weissel M, Ramach W. Surgical treatment of distant metastases in differentiated thyroid cancer: Indication and results. Surgery 1986;100:1088-97.  Back to cited text no. 4
    
5.Basu S, Abhyankar A. Adding surgery as a complementary approach to radioiodine therapy in patients of differentiated thyroid carcinoma with large solitary flat bone metastases: The unresolved Issues. J Surg Oncol 2012;105:622.  Back to cited text no. 5
    


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