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High Frequency of Bone/Bone Marrow Involvement in Advanced Medullary Thyroid Cancer

Oncology Research Department (E.M., A.F.-C., J.B., J.F.C., F.K.-B.), Inserm U601, 44093 Nantes, France; Nuclear Medicine Department (J.P.V.), University Hospital, 38043 Grenoble, France; Nuclear Medicine Department (S.B.), François Baclesse Cancer Center, 14021 Caen, France; Radiology (E.F., B.D.) and Endocrinology (B.C., A.M.) Departments, University Hospital, 44093 Nantes, France; Nuclear Medicine Department (L.F.), René Gauducheau Cancer Center, 44805 Nantes, France; and Garden State Cancer Center (D.M.G.), Center for Molecular Medicine and Immunology, Belleville, New Jersey 07109-0023

Address all correspondence and requests for reprints to: Françoise Kraeber-Bodéré, Oncology Research Department, Inserm U601, Institut de Biologie, 9 quai Moncousu, 44093 Nantes Cedex 1, France. E-mail: francoise.bodere{at}chu-nantes.fr.

High hematological toxicity has been observed with anti-carcinoembryonic antigen radioimmunotherapy (RIT) in medullary thyroid carcinoma (MTC), suggesting metastatic bone involvement (BI). This retrospective study evaluated the rate of BI in MTC patients enrolled in two phase-I/II RIT trials using anti-carcinoembryonic antigen x anti-diethylenetriamine pentaacetic acid bispecific antibodies and [¹³¹I]di-diethylenetriamine pentaacetic acid hapten. Thirty-five patients underwent bone scintigraphy, bone magnetic resonance imaging (MRI), and post-RIT immunoscintigraphy (IS). IS performed in MTC patients was compared with IS conducted in 12 metastatic colorectal carcinoma (CRC) patients. Quantitative analysis of bone uptake was performed in three MTC and three CRC patients. In the MTC group, bone scintigraphy detected BI in 56.6% of patients, MRI in 75.8%, and IS in 88.6%. BI was confirmed by undirected (random) bone marrow biopsy, by bone surgery, or by two positive imaging methods in 74.3% of the patients. Sensitivity per patient of bone scintigraphy, MRI, and IS were 72.7, 100, and 100%, respectively. In contrast, IS visualized BI in only 33.3% of CRC patients; bone uptake was lower in CRC than in MTC patients. Bone MRI combined with post-RIT IS disclosed a much higher BI rate in advanced MTC than previously reported in the literature.

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