Brain Metastases From Differentiated Thyroid Carcinoma: Prevalence, Current Therapies, and Outcomes

Abstract

Background and ObjectiveThe brain is an unusual site for distant metastases of differentiated thyroid carcinoma (DTC). The aim of this study was to document the prevalence of brain metastases from DTC at our institutions and to analyze the current therapies and the outcomes of these patients.MethodsWe performed a retrospective chart review of patients with DTC and secondary neoplasia of the brain.ResultsFrom 2002 to 2016, 9514 cases of thyroid cancer were evaluated across our institutions and 24 patients met our inclusion criteria, corresponding to a prevalence of 0.3% of patients with DTC. Fourteen (58.3%) were female and 10 (41.7%) were male. Fifteen patients had papillary thyroid cancer (PTC) (62.5%). Brain metastases were diagnosed 0 to 37 years (mean ± SD, 10.6 ± 10.4 years) after the initial diagnosis of thyroid cancer. Patients undergoing surgery had a median survival time longer than those that did not undergo surgery (27.3 months vs 6.8 months; P = 0.15). Patients who underwent stereotactic radiosurgery (SRS) had a median survival time longer than those that did not receive SRS (52.5 months vs 6.7 months; P = 0.11). Twelve patients (50%) were treated with tyrosine kinase inhibitors (TKIs), and they had a better survival than those who have not used a TKI (median survival time, 27.2 months vs 4.7 months; P < 0.05).ConclusionThe prevalence of brain metastases of DTC in our institutions was 0.3% over 15 years. The median survival time after diagnosis of brain metastases was 19 months. In our study population, the use of TKI improved the survival rates.

Evaluation of the impact of pre-operative stereotactic radiotherapy on the acute changes in histopathologic and immune marker profiles of brain metastases

“…As tumor microenvironments are related to primary tumor histology and molecular profile, this prevents extrapolation of the results of this study to other histologies not well represented as all histologies are distinct and underrepresented in this limited series. For example, certain histologies, such as renal cell carcinoma, melanoma, and thyroid cancer have innate tumor hemorrhage and necrosis, which would be difficult to differentiate from the effects of radiotherapy 38 . Further, although the majority of our patients had NSCLC, even within this entity, there are several molecular subtypes, and hence one cannot generalize these results to all tumor types and subtypes.…”

Brain Metastases From Differentiated Thyroid Carcinoma: A Retrospective Study of 22 Patients

“…Sheu ( 27 ) reported that two patients with DTC craniocranial metastases were treated with Lenvatinib combined with RAIT, which successfully improved their quality of life. Cristiane J ( 28 ) found that the median survival time after diagnosis of brain metastases was 19 months and the use of TKIs improved the survival rates. In the current series, one patient who treated with sorafenib after neurosurgery is now still alive.…”

Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging?

“…BM is an unusual event for patients with aggressive lymphoma [28,29]. Thyroid cancer remote metastasis to the brain occurred in about 0.3-4.6% of cases and was associated with aggressive behavior and worse prognosis [30][31][32].…”