Clinical outcomes of a cohort of patients with central nervous system metastases from thyroid cancer

INTRODUCTION: Metastases to central nervous system (M(1)-CNS) are rarely reported in thyroid cancer (TC) patients. We aimed to characterize patients with M(1)-CNS from TC followed in our department. METHODS: Review of the medical records of 27 patients with TC-related M(1)-CNS. RESULTS: Mean age at TC diagnosis was 56.9 ± 19.1 years. Papillary TC (55.6%) was the commonest histological type, followed by poorly differentiated (18.5%), medullary (11.1%), follicular (7.4%) and Hürthle cell (7.4%) carcinomas. Angioinvasion and extrathyroidal extension were observed in a high number of patients. At M(1)-CNS diagnosis, other distant metastases were already present in 77.8% of the patients. Treatment directed to M(1)-CNS was offered to 20 (74%) patients: 1 was submitted to surgery, 18 to radiotherapy (either whole-brain radiotherapy or stereotaxic radiosurgery or both) and 4 to surgery and radiotherapy. Four patients received cytotoxic chemotherapy and one was submitted to (131)I. Median survival since M(1)-CNS detection was 5.0 months. The only factor associated with better survival was surgery to brain metastases (P = 0.012). CONCLUSIONS: The management of these patients is very challenging given the inexistence of effective treatments, except for brain surgery in selected cases.