Moritani Sueyoshi, Takenobu Masao, Yasunaga Masakazu, Fujii Taihei, Kitano Hiroya
Eur Thyroid J. 2025 Jun 11;14(3). doi: 10.1530/ETJ-24-0237. Print 2025 Jun 1.
Treatment for distant metastases (DM) of differentiated thyroid cancer (DTC) aims to improve the prognosis and quality of life (QOL). Radioactive iodine and molecular targeted therapies are the primary systemic treatments for DM. Combining these with local treatments, such as surgery and radiotherapy targeting metastatic sites, may provide additional benefits to systemic therapy.
This study reviewed the additional effects of local therapies on common metastatic sites of DTC, such as pulmonary or bone metastases (BM), the efficacy of bone-modifying agents (BMAs) for BM, and the therapeutic effects of local treatments for less common brain metastases.
Although based on retrospective studies with no definitive conclusions on the effectiveness of each treatment, local therapy for DM in DTC patients has been shown to enhance prognosis and QOL in several studies. Considering the results of clinical trials for metastatic tumors, local therapy for one or a few pulmonary or BM in DTC should be considered, if expected to improve prognosis and QOL. Surgical intervention is recommended for spinal metastases presenting with spinal compression symptoms or for long BM in extremities at risk of pathological or impending fractures. BMAs are also recommended to reduce the risk of skeletal-related events. Surgery, stereotactic radiotherapy, and whole-brain radiotherapy are suggested for brain metastases to improve the prognosis and QOL.
Incorporating local therapy alongside systemic treatment can enhance the prognosis and QOL and should be considered a viable treatment option.
分化型甲状腺癌（DTC）远处转移（DM）的治疗旨在改善预后和生活质量（QOL）。放射性碘和分子靶向治疗是DM的主要全身治疗方法。将这些方法与局部治疗（如针对转移部位的手术和放疗）相结合，可能会为全身治疗带来额外益处。
本研究回顾了局部治疗对DTC常见转移部位（如肺或骨转移（BM））的附加效果、骨改良剂（BMA）对BM的疗效以及局部治疗对较少见的脑转移的治疗效果。
尽管基于回顾性研究，对每种治疗的有效性尚无定论，但在一些研究中已表明，DTC患者DM的局部治疗可改善预后和生活质量。考虑到转移性肿瘤的临床试验结果，如果预期能改善预后和生活质量，对于DTC中一处或少数几处肺或BM转移应考虑局部治疗。对于出现脊髓压迫症状的脊柱转移或四肢有发生病理性骨折或即将发生骨折风险的长BM转移，建议进行手术干预。还建议使用BMA以降低骨相关事件的风险。对于脑转移，建议进行手术、立体定向放疗和全脑放疗以改善预后和生活质量。
将局部治疗与全身治疗相结合可改善预后和生活质量，应被视为一种可行的治疗选择。
