Cerebral metastases from thyroid carcinoma: complete remission following radioiodine treatment.

BACKGROUND: Brain metastases arise in roughly 0.9% of all cases of differentiated thyroid cancer. The median survival of adult patients with thyroid carcinoma that has metastasized to the brain is less than one year. Radioactive iodine treatment is only rarely given because its efficacy is not documented. In children, the situation may be different. METHOD: In 2005, a 15-year-old girl underwent thyroidectomy, and an oxyphilic variant of papillary thyroid carcinoma was found in ectopic thyroid tissue. The patient underwent oral, high-dose radioactive iodine treatment. The post-therapeutic I-131 whole-body scan revealed multiple metastases in the skeleton, lungs, and the soft tissues, along with physiological uptake of the residual thyroid tissue. Magnetic resonance imaging of the head revealed two brain metastases. RESULTS: When the initial treatment was completed, additional age-adapted high-dose radioactive iodine treatment was given, up to a total activity level of 35 GBq. There followed a complete remission of all metastases in the brain, bones, lungs, and soft tissues. Computed tomography of the chest revealed stable residuals. Over the ensuing 7.5 years of follow-up, the thyroglobulin values steadily declined to less than 2 ng/mL. The patient was asymptomatic at her last follow-up in May 2013. She did not develop any delayed reaction to high-dose radioactive iodine treatment (in particular, she did not develop leukemia or any other secondary malignancy). She remained fertile: after completion of the treatment, she had two healthy children. CONCLUSION: In this patient with multifocal thyroid carcinoma, a rare entity, radioactive iodine treatment was successful as the single treatment. This case illustrates the point that a given therapeutic modality might succeed in an individual case despite a total or near-total lack of efficacy for most patients in the same situation.

Nutritional status of children and young adults with Ewing sarcoma or osteosarcoma at diagnosis and during multimodality therapy.

OBJECTIVE: Objective of our study was to evaluate the nutritional status and growth of children and adolescents with common malignancies of the musculoskeletal system at diagnosis, and undergoing multimodality therapy. METHODS: A retrospective analysis of data from 2001 to 2009 was conducted. Hospital charts were used as a source of clinical data. Primary endpoint of the analyses was to identify variations in anthropometric parameters at diagnosis and during the first 2 years of follow-up in children and adolescents with osteosarcoma or Ewing sarcoma. Factors contributing to disorders of growth in this population were sought. RESULTS: A total of 139 children were registered, 62 with Ewing sarcoma and 77 with osteosarcoma. At diagnosis 72.7% of all patients were classified as adequately nourished (BMI 5th to <85th percentiles). During treatment all anthropometric parameters were markedly reduced (P < 0.001) in both groups with extreme changes in body weight from -30% to +44%. This was pronounced in children affected by osteosarcoma (P < 0.05). During follow-up, recovery of body weight was noted in both groups. Height Z-scores remained low (P < 0.001) in comparison to the general population. After the observation period 43.4% of the children with osteosarcoma and 25.5% of the patients with Ewing sarcoma demonstrated an altered body mass. CONCLUSIONS: Pediatric patients with Ewing sarcoma or osteosarcoma are at an increased risk for developing malnutrition, in the form of either over- or underweight during multimodality therapy. Early recognition of abnormal body mass is required to prevent and to treat long-term comorbidities caused by malnutrition.