Article
Brain metastases from thyroid carcinoma – surgical treatment and outcome
Zerebrale Metastasierung bei Schilddrüsenkarzinom – chirurgische Therapie und Ergebnisse
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Authors
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Majid Esmaeilzadeh
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Jörg Andreas Müller
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Manolis Polemikos Polemikos
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Elvis J. Hermann
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Frank Bengel
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
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Joachim K. Krauss
- Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Intracranial metastases from thyroid cancer are rare. Although the prognosis of thyroid cancer patients is generally favorable, the prognosis of patients with intracranial metastases from thyroid cancer has been considered unfavorable having a lower survival rate than those without intracranial involvement. Many questions about their management remain unclear. The aim of this study is was to analyze the characteristics, treatments, and outcomes of patients with brain metastases from thyroid cancer.
Methods: Among 4320 patients with thyroid cancer recorded in our institutional databases between 1989 and 2019, 20 patients with brain metastasis were retrospectively collected and analysed. The clinical characteristics, histological type of primary cancer and metastatic brain tumor, additional previous distant metastasis, treatment modalities, locations and characteristics on radiologic findings, time interval between the first diagnosis of the primary thyroid cancer and brain metastasis, thyroglobulin level at the first detection of intracranial metastasis and survival were analyzed.
Results: The mean age at initial and diagnosis was 59.4 years and at the manifestation of cerebral metastasis 64.0 years. The histological types of the primary thyroid cancers were papillary in ten patients, follicular in seven, and poorly differentiated carcinoma in three. The average interval between the diagnosis of thyroid cancer and brain metastasis was 4.4 years (range, 0–15 years). The Karnofsky Performance Status (KPS) at the time of diagnosis of brain metastases was more than 80 % on average. Twelve patients had a single intracranial lesion, 5 patients had 2 or 3 lesions, and 2 patients had 4 and 5 lesions, respectively. Fifteen patients underwent surgical resection. Whole-brain radiotherapy or tyrosine kinase inhibitors were applied as postoperative adjuvant treatment, and radiotherapy and stereotactic radiosurgery was performed in 4 patients. Overall survival time ranged between 0.5 and 77 months after diagnosis of intracranial metastasis.
Conclusion: Patients with thyroid cancer can develop brain metastasis even after many years. An early diagnosis appears important to achieve a better prognosis. Surgical resection and adjuvant treatments in the contemporary era could improve survival time as compared to historical data.
