Multimodal approach to the treatment of patients with radioiodine refractory differentiated thyroid cancer and metastases to the central nervous system

• Published in: Cancer medicine (Malden, MA) Vol. 11; no. S1; pp. 33 - 39
• Main Author: Alonso‐Gordoa, Teresa
• Format: Journal Article
• Language: English
• Published: Bognor Regis John Wiley & Sons, Inc 01-10-2022; John Wiley and Sons Inc; Wiley
• Subjects: Cancer therapies; Central nervous system; Clinical trials; differentiated thyroid cancer; Kinases; Medical prognosis; Metastases; Metastasis; Nervous system; Patients; Protein-tyrosine kinase; Radiation therapy; radiosurgery; radiotherapy; Review; Surgery; Thyroid cancer; Tumors; tyrosine kinase inhibitors
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4901

The diagnosis of central nervous system metastases in patients with radioiodine refractory differentiated thyroid cancer is a late and rare event that occurs in less than 1% of patients. Definitive conclusions on the overall clinical management cannot be drawn due to the limited number of patients included in retrospective series or post hoc analysis from clinical trials. However, most data show a trend to an increased benefit from a multimodal approach. Local treatment based on surgical and/or radiation techniques is highly encouraged for symptom control and to reduce tumor burden in this location despite a high risk of clinical complications. In addition, systemic treatment with novel tyrosine kinase inhibitors has demonstrated activity in this subgroup of patients, improving an otherwise unfavorable prognosis.
Central nervous system metastases in patients with radioiodine refractory differentiated thyroid cancer is rare, so the definitive clinical management remains uncertain. However, there is a trend to an increased benefit from a multimodal approach of local surgical and/or radiation techniques and systemic treatment with novel tyrosine kinase inhibitors. The article presents a review of the current data available for this treatment approach.