Download CHEMIOEMBOLIZZAZIONE DI MTS EPATICHE

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
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
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
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
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)
Drug-Eluting Beads on Thyroid Cancer Metastases
Sept 2009: SORAFENIB (400 mg/day)
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)
 Nov 2009: liver PR (31mm vs 40 mm)
 Feb 2010: liver PD (50 mm vs 31 mm)
Drug-Eluting Beads on Thyroid Cancer Metastases
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%)
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
Drug-Eluting Beads on Thyroid Cancer Metastases
Lesson learned from HCC…
Varela et al. J Hepatol, 2007
DEB-TACE
C-TACE
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
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
Drug-Eluting Beads on Thyroid Cancer Metastases
Pre-TACE: CT and PET-CT
3 monts Post-TACE: CT and PET-CT
Drug-Eluting Beads on Thyroid Cancer Metastases
PRE-TACE PET-CT
3 Months POST-TACE PET-CT: Local relapse and bone mets
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
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
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
Drug-Eluting Beads on Thyroid Cancer Metastases
6
Months
12
Months
New lesions
Treated lesions
Synergic effect of DEB-TACE + Sorafenib (ongoing) ?
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
- Uncertain benefit of adjuvant anti-neoangiogenic
therapy
… waiting for SPACE trial
Aknowledgements
Dr. Camillo Aliberti
Dr. Gianluca Stoppa (TERUMO Italy)
www.chemioembolizzazione.it (site under construction)
[email protected]
Bigger Bead available on the market: 120mm size
First Man-Eluting Bead loadable with a medium size IR
- Safe
- Comfortable