Therapy of a Patient with a Solitary Vertebral Metastasis


Question

I have a patient who had a 3.5 cm follicular carcinoma reoccur as a solitary vertebral met 13 years later..Thyrogobulin rose to max of 63 during the reoccurrence-we treated with local externall radiation and high dose I131--one year later the thyroglobulin is 7 clinically she feels well- no major pain and neurologically intact-(it is lowest lumbar body)--What are my options?-the neurosurgeons say resection would be a fairly large surgery because the vertebral body resection would require pelvic restructuring--The literature on vertebral embolization is largely from the Netherlands-do you have good US experience with this procedure? Is simple follow-up enough at this point? What is your experience with solitary vertebral mets? Thanks Jeffrey Sanfield,M.D, F.A.C.P., Ann Arbor Endocrinology,Ann Arbor , Michigan.My Email is Sanfiel@trinity-health.org

Response

Solitary mets are of course rare. The two that I cared for involved lung (resected and cured) and the humerus (treated with 131-I then resected, and cured). I believe that embolization has been used in patients with large tumor deposits, which I think your patient does not have, and helps, but does not cure the lesion.

One option would be to re-treat with 131-I, and this seems the most probably useful. I presume the maximum radiotherapy was given. The TG of 7 (on T4?) is low enough to mean that growth is not rapid. After repeat 131-I it may be logical to follow the situation on suppressive doses of T4 and wait for a sign of growth by increasing TG. This might take years. I have never been involved in resection of a vertebrae, so I can not comment on that approach. I have installed Harrington rods in a few patients to stabilize their spine when multiple vertebrae had mets, and some contemporary version of this procedure may also be useful. Leslie J De Groot,MD