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Embolization in combination with radioiodine therapy for bone metastases from differentiated thyroid carcinoma
Author(s) -
Van Tol K. M.,
Hew J. M.,
Jager P. L.,
Vermey A.,
Dullaart R. P. F.,
Links T. P.
Publication year - 2000
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.2000.00998.x
Subject(s) - medicine , embolization , thyroid carcinoma , bone metastasis , thyroidectomy , thyroid , thyroglobulin , bone pain , metastasis , carcinoma , urology , gastroenterology , radiology , surgery , cancer
BACKGROUND The outcome for patients with bone metastases from differentiated thyroid carcinoma is worse compared to the overall prognosis of patients with differentiated thyroid carcinoma. The aim of this study is to evaluate the effect of embolization with concomitant radioiodine treatment on the serum thyroglobulin (Tg) level, pain and neurological symptoms in patients with large bone metastases from differentiated thyroid carcinoma. PATIENTS AND METHODS Five symptomatic patients, who presented with a large unresectable bone metastasis of differentiated thyroid carcinoma were treated with radioiodine and embolization. The effect of this combined treatment was compared to the effect of radioiodine without embolization in a previously treated control group of 6 patients. Serum Tg levels, pain and neurological symptoms were scored. Both groups were treated similarly with total thyroidectomy followed by ablation with 5.55 GBq 131 I and a second dose of 5.55 GBq 131 I three months later, except for embolization in the embolization group, which took place between the 2 radioiodine treatments. RESULTS In the embolization group, serum Tg at the second 131 I therapy had decreased by 88.7% (median, range: 77.1–99.3%), which was significantly more compared to the decrease of serum Tg in the control group (18.6%, range: −4.7–95%, P < 0.05). CT‐scanning showed a median volume reduction of the metastasis after radioiodine treatment combined with embolization of 52.5% (range: 39–80%). Both strategies resulted in a rapid relief of pain and neurological symptoms. Embolization was not accompanied with severe complications. CONCLUSIONS This preliminary study suggests that embolization of bone metastases of differentiated thyroid carcinoma in combination with radioiodine treatment results in a significant initial reduction of serum Tg level compared to radioiodine treatment alone. This suggests a beneficial reduction in tumour burden. In this patient category, embolization appears to be a safe and well tolerated procedure.