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Drug-Eluting Beads on Thyroid Cancer Metastasis: Early Experience of an Oncological Center

Istituto per la Ricerca e la Cura del Cancro Candiolo (Torino) Interventional Radiology Unit Chief: Dr G.C.Anselmetti Radiology Dept - Chief Dr D.Regge. Drug-Eluting Beads on Thyroid Cancer Metastasis: Early Experience of an Oncological Center. Dr ANTONIO MANCA MD, PhD.

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Drug-Eluting Beads on Thyroid Cancer Metastasis: Early Experience of an Oncological Center

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  1. Istituto per la Ricerca e la Cura del Cancro Candiolo (Torino) Interventional Radiology Unit Chief: Dr G.C.Anselmetti Radiology Dept - Chief Dr D.Regge Drug-Eluting Beads on Thyroid Cancer Metastasis: Early Experience of an Oncological Center Dr ANTONIO MANCA MD, PhD

  2. Istituto per la Ricerca e la Cura del Cancro Candiolo (Torino) Interventional Radiology Unit Chief: Dr G.C.Anselmetti Radiology Dept - Chief Dr D.Regge Drug-Eluting Beads on Thyroid Cancer Metastasis: VERY Early Experience of an Oncological Center Dr ANTONIO MANCA MD, PhD

  3. Drug-Eluting Beads on Thyroid Cancer Metastases Thyroid Cancer is found in one third of autoptic specimen* • < 5% of thyroid nodules undergone FNA are T. cancer • < 5% of Thyroid cancer gives distant metastases • 75%-85% papillary cancer with no mets or just N+ • most of distant mets to lungs and bone 0,5 % of patients with Thyroid Cancer have liver metastases (up to 50% of pts w/ medullary thyroid cancer: 5-8% of ThyCa) * Harach et al. "Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study.” Cancer 1985 56 (3): 531–8

  4. Drug-Eluting Beads on Thyroid Cancer Metastases Male Patient, 70 y.o. 1998 - Radical Prostatectomy for AdenoCarcinoma 2000 - Local recurrence: RT 70Gy and Casodex (ongoing, PSA t: 0,1-0,3) 2009 - Neck palpable nodule US: Thyroid node (25 mm) on right lobe Biopsy: HURTHLE CELL CARCINOMA March 2009: Total Thyroidectomy (pT2pN0) and I 131

  5. Drug-Eluting Beads on Thyroid Cancer Metastases July 2009: • - CT and PET-CT: multiple liver mets (biopsy: Hurthle cell Ca) • - Initial local recurrence and single cervical lymph node met • - No indication to I131 therapy • unresponsive: - brief disease free survival • - no I131 uptake of mets • (like most of Hurhle cell Ca)

  6. Drug-Eluting Beads on Thyroid Cancer Metastases Sept 2009: SORAFENIB (400 mg/day) • Nov 2009:liver PR (31mm vs 40 mm) • Feb 2010: liver PD (50 mm vs 31 mm) Phase II Trial of Sorafenib in Advanced Thyroid Cancer Gupta-Abramson et al. JCO 2008 Vol 26, No 29: 4714-4719 30 pts - 77% overall clinical benefit (23% PR and 54% SD)

  7. Drug-Eluting Beads on Thyroid Cancer Metastases

  8. Drug-Eluting Beads on Thyroid Cancer Metastases • SIE-AIMN-AIFM (Italian) Guidelines for Thyroid Cancer Treatment: TACE (and/or RFA) for unresectable liver metastases (treatment of liver mets not mentioned in American guidelines) • Doxorubicin in metastatic thyroid cancer: Bonadonna et al. Cancer Res 1970 Gottlieb Cancer 1972 Haugen et al. Semin Surg Oncolm 1999 Sherman et al. (M.D.Anderson Cancer Center) Clinical Oncology 2010 Chemotherapy with Doxorubicin in Progressive Medullary and Thyroid Carcinoma of the Follicular Epitelium Matuszczyk et al. Horm Metab Res 2008; 40: 210-213 22 pts. 27 % Hurthle-cell tumors 5% PR, 42% SD, 53% PD Side effects: Hair loss (42%), Nausea (23%), Resp. Infection (13%), Neutropenia (10%) Pneumonia (7%)

  9. Drug-Eluting Beads on Thyroid Cancer Metastases 11 Patients: TACE with Lipiodol and Doxorubicin Lorenz et al. Surgery 2005 vol. 138 (6) pp. 986-93 12 Patients: TACE with Lipiodol and Doxorubicin PR 42%, SD 42% Fromigue‘ et al. J Clin Endocrinol Metab 2006 vol. 91 (7) pp. 2496-9

  10. Drug-Eluting Beads on Thyroid Cancer Metastases Lesson learned from HCC… Varela et al. J Hepatol, 2007 DEB-TACE C-TACE

  11. Drug-Eluting Beads on Thyroid Cancer Metastases Chemoembolization (TACE) with 100-300 micron DC Beads loaded with 37,5 mg/mL of DOXORUBICIN First selective TACE with 100mg of Doxorubicin on the main lesion in segment VIII (5 cm) Pre-TACE Ondasetron Ranidil During-TACE Fentanil Midazolam Post-TACE Tramadol Ondasetron Prednisone CEUS pre-TACE CEUS post-TACE

  12. Drug-Eluting Beads on Thyroid Cancer Metastases March-June 2010: 4 selective TACE sessions (40 -100mg di Doxorubicin per session, 3-4 weeks intervals) No major complications Good compliance for the first three sessions G2 Pain, nausea and vomiting in the last session

  13. Drug-Eluting Beads on Thyroid Cancer Metastases Pre-TACE: CT and PET-CT 3 monts Post-TACE: CT and PET-CT

  14. Drug-Eluting Beads on Thyroid Cancer Metastases PRE-TACE PET-CT 3 Months POST-TACE PET-CT: Local relapse and bone mets

  15. Drug-Eluting Beads on Thyroid Cancer Metastases July 2010 - CT and PET-CT: • Size decrease and good necrosis of bigger lesions (34 mm vs 50 mm) with minor viable tissue percentage (10% in S8) • Complete necrosis of smaller lesions treated but… • Neck local relapse and cervical node metastasis • Bone metastases (detectable only with PET-CT) The metastatic disease is no longer“Liver dominant” No more DEB-TACE sessions

  16. Drug-Eluting Beads on Thyroid Cancer Metastases “TAKE HOME MESSAGE” • DEB-TACE with DC Bead in this preliminary experience • of metastatic Hurthle cell Carcinoma showed: • Safety • Good patient compliance • Local control of liver metastases • despite extrahepatic progression

  17. Drug-Eluting Beads on Thyroid Cancer Metastases Mild neck discomfort Moderate sciatic pain Pain and discomfort relief after Radiotherapy on Neck and L4-L5 ECOG 0, PS 90% Liver function not impaired

  18. Drug-Eluting Beads on Thyroid Cancer Metastases 6 Months 12 Months New lesions Treated lesions Synergic effect of DEB-TACE + Sorafenib (ongoing) ?

  19. Drug-Eluting Beads on Thyroid Cancer Metastases “LESSON LEARNED” • DEB-TACE with DC Bead in this preliminary experience • of metastatic Hurthle cell Carcinoma: • - Safe and effective in liver disease control • Should be repeated until disappearance of viable tissue • Uncertainbenefit of adjuvant anti-neoangiogenic therapy … waiting for SPACE trial

  20. Aknowledgements Dr. Camillo Aliberti Dr. Gianluca Stoppa (TERUMO Italy) www.chemioembolizzazione.it (site under construction) anto.manca@gmail.com

  21. Bigger Bead available on the market: 120mm size

  22. First Man-Eluting Bead loadable with a medium size IR - Safe - Comfortable

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