FOLLICULAR THYROID-CANCER - CLINICAL OUTCOME AND IMPACT OF RADIOIODINE THERAPY IN PATIENTS WITH DISTANT METASTASES

Patients with differentiated thyroid cancer generally have a good prog nosis and high cure rates; however, subgroups of patients exist who de velop progressive disease with significant morbidity and mortality. We analyzed the clinical outcome of patients with follicular thyroid can cer and distant metastases to define their presentation, impact of the rapy and clinical outcome. A group of 44 patients with follicular thyr oid cancer which had metastasized to the lungs or the skeleton was ide ntified. All patients were treated at M.D. Anderson Cancer Center betw een 1965 and 1994. The group included 26 women and 18 men, with a medi an age of 56 years (range, 23 to 80 years). The primary tumor was limi ted to the thyroid in most cases. At the time of writing 13 patients w ere alive with metastatic disease a median of 43 months (range, 4 to 2 30 months) after diagnosis, while 27 patients died of thyroid cancer a median of 83 months (range, 4 to 238 months) after diagnosis. Bone pa in was the chief complaint in almost all the 24 patients in whom dista nt metastases were present at diagnosis. In the 20 patients who initia lly presented with localized disease, distant metastases to the skelet on and/or lungs were detected after a median interval of 53 months (ra nge, 8 to 216 months). Symptomatic spinal cord compression occurred in 13 patients and preceded their death by 4 to 34 months. Radioiodine u ptake was seen in most bone metastases but in only about half of metas tatic foci in the lungs. Radiotherapy was palliative and useful for bo ne metastases. We conclude that patients with follicular thyroid cance r and distant metastases have a distinct clinical profile that include s prominent skeletal and pulmonary involvement and substantial morbidi ty and mortality. Intensive multimodality therapy is required to optim ize the clinical outcome.