[Sternal metastasis from differentiated thyroid carcinoma: what management?].

OBJECTIVE

The aim of this study was to evaluate results of surgical management for sternal metastasis from differentiated thyroid carcinoma.

METHODS

A retrospective study has been completed on patients treated in our department for sternal metastasis from differentiated thyroid carcinoma.

RESULTS

Among the 235 patients who underwent thyroidectomy for thyroid cancer, seven (3%) had sternal metastasis during follow-up. These sternal metastasis were metachronous with an average delay of 10 years. Treatment corresponded to an excision of the upper half of the sternum including internal parts of the clavicle and the adjacent ribs (four cases), a reduction of the metastatic tumour mass (two cases) and one biopsy with no resection (one case). After sternal excision, reconstruction of the chest wall was obtained with the use of polyester prosthesis covered with pectoral muscle flap. Radioiodine was assigned to all patients as a complementary therapy. With an average follow-up of 58 months, no local or distant recurrence was observed in five patients (71%). Two patients had local and/or distant metastasis.

CONCLUSION

Incidence of sternal metastasis is rare but does not preclude a large surgical resection. When possible, an aggressive management (surgical resection and radioiodine therapy) allows more than 70% relapse-free survival at 5 years.