Percutaneous osteoplasty combined with radioiodine therapy as a treatment for bone metastasis developing after differentiated thyroid carcinoma.

BACKGROUND: Bone metastasis developing after differentiated thyroid carcinoma (DTC) is common, and in most cases, this condition leads to osteolysis. However, treatment of bone metastases in DTC patients is a great challenge. The purpose of this study was to evaluate the effectiveness of percutaneous osteoplasty (POP) combined with radioiodine therapy for treating bone metastasis developing after DTC. PATIENTS AND METHODS: We retrospectively studied 8 patients who had undergone POP combined with radioiodine therapy for bone metastases after DTC. All patients underwent total thyroidectomy and were administered an oral dose of 131I (3.7 GBq, 100 mCi) for ablation of the residual thyroid. Thereafter, a POP was performed at 2 to 3 months followed by 2 to 5 sessions of radioiodine therapy every 4 to 6 months after the first 131I therapy. The therapeutic effectiveness of this treatment was evaluated on the basis of the changes in serum thyroglobulin (Tg) level and imaging characteristics, palliation of bone pain, and alleviation of neurologic symptoms.
RESULTS: After POP, the mean serum Tg level decreased by 86.0% (range, 68.1%-99.3%). The mean serum Tg level markedly declined further by 67.4% (range, 37.1%-90.2%) after repeated radioiodine therapy. All the patients experienced immediate and substantial alleviation of bone pain and neurologic symptoms, and their quality of life markedly improved. The bone-destructive lesions were filled with bone cement to enhance skeletal stability. No severe complications developed.
CONCLUSION: POP, a minimally invasive procedure, combined with radioiodine therapy seems to be highly effective in providing pain relief and bone stability and in improving the quality of life of DTC patients with bone metastases. After POP, radioiodine therapy is essential.