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Thyroid Cancer Brain Metastasis

Survival and Genomic Characteristics of a Large Tertiary Care Cohort

Osborne, Joseph R., MD, PhD*; Kondraciuk, Jessica D., MD; Rice, Samuel L., MD; Zhou, Xiaosun, MD, PhD; Knezevic, Andrea, MS§; Spratt, Daniel E., MD; Sabra, Mona, MD; Larson, Steven M., MD†**††; Grewal, Ravinder K., MD†††

doi: 10.1097/RLU.0000000000002618
Original Articles

Purpose Brain metastases (BMs) in patients with differentiated thyroid cancer (DTC) are rare but associated with poor prognosis. We examined risk factors for overall survival (OS) in this population and explored the pattern of genomic alterations.

Methods Single-institution, retrospective review of all patients with DTC from January 2000 to November 2016 identified 79 patients for analysis. Multiple prognostic factors, including age, gender, distal metastasis (DM), diagnosis time, DM sites, BM diagnosis time, BM number and size, genomic sequencing data, craniectomy, external beam radiation therapy, and kinase inhibitor therapies, were evaluated. Univariate and multivariate analyses were performed.

Results Median survival after BM was 18 months. One- and 3-year survival rates were 63% and 33%, respectively. Univariate analysis identified 4 covariates correlated with prolonged survival: time between DTC diagnosis and BM for less than 3 years (P = 0.01), time from initial DM diagnosis to BM for 22 months or less (P = 0.03), 3 BM sites or fewer (P = 0.002), and craniectomy (P = 0.05). Multivariate model revealed 3 variables associated with OS: DTC diagnosis to BM time of less than 3 years (P = 0.04), craniectomy (P = 0.06), and patients with fewer than 3 BM sites (P = 0.06). The majority of patients with BM had a telomerase reverse transcriptase promoter mutation, However, mutational status was not an independent predictor of survival.

Conclusions For BM from DTC, time interval between DTC diagnosis and BM, number of BM sites, and craniectomy were independently associated with OS. Further studies are needed to define the role of genomic mutations in advanced cancer.

From the *Department of Radiology, Weill Medical College of Cornell University; and

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY;

Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;

§Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI;

Department of Medicine, Memorial Sloan Kettering Cancer Center;

**Molecular Pharmacology Program, Sloan Kettering Institute; and

††Center for Targeted Radioimmunotherapy and Theranostics, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY.

Received for publication October 26, 2018; revision accepted March 30, 2019.

J.R.O. and J.D.K., co–first authors, contributed equally to this work.

Conflicts of interest and sources of funding: This study was supported by R01 CA201250-01A1 “124I-NaI PET: Building Block for Precision Medicine in Metastatic Thyroid Cancer” grant (to J.R.O., R.K.G., S.M.L.), as well as by the Center for Targeted Radioimmunotherapy and Diagnosis and the Ludwig Center for Title page 2 Cancer Immunotherapy. This research was also funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support grant P30 CA008748. The authors declare no conflict of interest.

Correspondence to: Joseph R. Osborne, MD, PhD, Department of Radiology, New York–Presbyterian Weill Cornell Medical Center, 520 E 70th St, Starr-2, New York, NY 10021. E-mail:

Online date: May 17, 2019

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