VERTEBRAL METASTASIS FROM THYROIDAL ORIGI N - A SERIES OF 37 CASES

Purpose of the study Define a specific therapeutic for spinal metastas is from thyroidal origin. Material A retrospective series of 37 patien ts treated between January 1978 and January 1993 was made. The sex rat io was 29 women for 8 men with an average age of 59,5. The prevalent h istology has a vesicular type (19 cases which represents 51 per cent). The metastasis are mostly found at the dorsal level (48,6). Methods T he different parameters analysed for this study of 37 patients were : invaded segment of the vertebra (anterior, middle, posterior or total) , Tokuhashi score, epiduritis extent, patient age, histological type a nd iodiosensibility. Results Out of 37 patients, 3 were lost for follo w-up, 7 metastasis were treated carcinologically (''en bloc'' resectio n). 30 were treated palliatively depending on the clinical symptoms : neurological, mechanical, or pain. The osseous metastasis exists in 56 per cent of the cases at the time the primitive neoplasy was discover ed, and their presence burdens the final prognostic. 21 patients died with an average survival of 21 months, 13 patients survived with a mea n follow-up of 50 months, 50 per cent of the patients had a vertebra t otally involved with only 13 patients with neurological signs (4 Frank el A, 3 Frankel B, 4 Frankel C and 2 Frankel D). Discussion The analys is of the results shows that the pejorative criteria in case of verteb ral metastasis of thyroidal cancer are the score of Tokuhashi inferior to 7, the whole affected vertebra, the epiduritis on 3 levels, the ag e of the patient superior to 65 and the idiosensiblity of the metastas e. The surgery do called carcinological gives very good results with 5 surviving patients out of 7. Conclusion When reading this study it se ems that, in front of vertebral metastasis from thyroidal origin, we s hould choose the most radical therapeutic attitude as much as possible . This strategy finds its justification by the fact that the thyroidal cancer spreads out slowly giving a survivorship superior to 12 months in case of metastatic vertebral affection. The importance of the tumo ral reduction is connected with the efficiency of the iodiotherapy (fo r differentiated histological types). This is a considerable adjuvant treatment for this kind of cancer