This case series report illustrates the experience in the management of diagnosis and treatment for brain metastases from DTC in our center. Multi-modalities are indicated in the diagnosis and treatment of brain metastases from DTC.
The prevalence of brain metastases from DTC in our center was rare (0.1%), in keeping with published prevalence rates between 0.15 – 1.3% [9,10,11]. The symptoms of brain metastases are nonspecific, such as headache, focal neurologic dysfunction, cognitive dysfunction, seizures, and stroke [12]. Hence, it is challenging to make a diagnosis based on clinical symptoms. In our report, symptomatic patients were sent for MRI to diagnose brain metastases. However, some brain lesions were incidentally detected by 18F-FDG PET/CT and 131I-SPECT/CT in asymptomatic patients. MRI is the preferred imaging modality to assess brain metastasis with higher sensitivity and specificity as compared to other modalities [13, 14]. Systemic brain imaging such as MRI, CT, and 18F-PET/CT was recommended for screening metastases in radioiodine refractory DTC before tyrosine kinase inhibitor therapy in a multi-center report [15]. 18F-FDG PET/CT is a useful tool for screening metastases. In our center, a dedicated head and neck protocol using contrast enhancement was applied to improve sensitivity and specificity in detecting brain and other metastases in patients with high thyroglobulin levels and negative radioiodine scans. However, brain metastases might be found in patients with DTC together with other distant metastases by 131I -whole body scan. And 131I-SPECT/CT is recommended to confirm the location of brain metastases. Nuclear physicians and oncologists must be aware of the clinico-histopathological heterogeneity of PTC in order to make the early diagnosis of unexpected brain metastasis [16].
Bạn đang xem: Screening and treatment of brain metastasis from papillary thyroid carcinoma: a case series
Xem thêm : Maximizing Flavor: The Art and Science Behind Perfect Pizza Toppings at Doreen’s Pizzeria
The decision-making for treatment of brain metastases in DTC depends on several clinical factors such as systemic tumor burden, histopathology type, radioiodine avidity, and location of the tumor. Four patients in our study benefited from surgery and SRS. Neurosurgical resection seems to be the primary treatment for symptomatic, isolated focal, or less than three tumors with good performance status. Few retrospective studies have confirmed that OS is significantly longer in the resectable brain metastases group in comparison with the unresectable group [17, 18]. Radiotherapy, including whole-brain radiotherapy, SRS, or focussed external beam radiotherapy could be the second option after surgery [19]. Among radiotherapy modalities, SRS is a powerful local treatment modality that can be affective in small, multiple, and deep metastases [20]. SRS has been associated with a higher local control rate and longer OS than those who did not receive this treatment method [21].
Systemic control using tyrosine kinase inhibitors Sorafenib or Lenvatinib combined with radioiodine may improve the progression-free survival and quality of life for patients with radioiodine-refractory DTC [22, 23]. In our study, only one patient was eligible for Sorafenib but he refused the treatment. In differentiated PTC, the role of radioiodine in improving the outcome of brain metastases remains unclear. However, a patient with radioiodine uptake may have a better prognosis than one without radioiodine uptake. Sheu et al. reported that radioiodine combined with other treatment modalities may improve the quality of life in a small number of patients (24). However, the adverse effects of radioiodine therapy were hemorrhage and cerebral edema. In our study, radioiodine combined with TSH suppression and steroids was used to reduce brain tissue edema.
Xem thêm : How To Order Low Carb at Panda Express
Brain metastases from DTC are associated with poor prognosis. The OS in our study was longer than that in the previous studies [2, 17]. The different results might be related to histopathology. The primary tumor in our study was DTC. Meanwhile, other studies included tumors with more aggressive histopathological types such as anaplastic and medullary thyroid carcinoma. In addition, two patients in our study showed radioiodine uptake in the brain lesions and other distant metastases, and tumors with radioiodine uptake tend to show a better prognosis than tumors with non-radioiodine uptake.
Our study has several limitations. The follow-up period was short and the number of cases was small. Cases of brain metastases were selected from a limited period between 2016 to 2022. The evidence for PTC in the primary tumor was based on histopathological images in 4 out of 5 patients (cases 1-4). We lacked histopathological image for case 5, and the evidence of PTC was based on the histopathological report. Furthermore, we did not use of tyrosine kinase inhibitors for any of our patients with brain metastases from DTC.
Nguồn: https://buycookiesonline.eu
Danh mục: Info
