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Definitive Radiotherapy for Oligometastatic and Oligoprogressive Thyroid Cancer: A Potential Strategy for Systemic

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Definitive radiotherapy (dRT) offers excellent local control and delays systemic therapy for metastatic thyroid cancer patients with limited disease spread. This safe, repeatable treatment strategy shows promise for improving outcomes in this population.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Definitive radiotherapy (dRT) is established for oligometastatic/oligoprogressive cancers but understudied in metastatic thyroid cancer.
  • Metastatic thyroid cancer often presents with limited sites amenable to localized treatment.

Purpose of the Study:

  • To evaluate the efficacy and safety of definitive radiotherapy (dRT) in patients with oligometastatic and oligoprogressive metastatic thyroid cancer.
  • To assess the impact of dRT on local control, progression-free survival, and the need for systemic therapy escalation.

Main Methods:

  • Retrospective cohort study of 119 metastatic thyroid cancer patients treated with 207 dRT courses for 344 sites between 2005-2024.
  • Patients had oligometastatic (34%) or oligoprogressive (66%) disease, mostly radioiodine-refractory.
  • Treatments were prescribed for definitive control (median BED10, 72 Gy); palliative RT was excluded. Somatic mutation testing was performed.

Main Results:

  • High 3-year actuarial local control rate of 91% per site.
  • Median progression-free survival (PFS) of 17 months; poorly differentiated histology associated with worse PFS, BRAF mutation with improved PFS.
  • Median freedom from systemic therapy escalation of 4.1 years; Grade 3 toxicity in 1.5% of courses, no Grade 4-5 events.

Conclusions:

  • Definitive radiotherapy (dRT) is a feasible strategy to defer systemic therapy escalation in metastatic thyroid cancer.
  • Sequential dRT courses provide excellent local control and are safe for repeated delivery to multiple sites.
  • Further research is warranted to confirm dRT's role in a multidisciplinary approach for metastatic thyroid cancer.