Local control after stereotactic radiation for thyroid cancer: a histology risk-stratified analysis
- 1Northwell Health , , ,
Abstract
Purpose/Objective(s): Recurrent and metastatic non-anaplastic thyroid cancer has traditionally been considered relatively radioresistant. We evaluated whether anatomic site or histology risk group better predicts local control (LC) following stereotactic radiation therapy (SBRT/SRS).
Materials/Methods: We retrospectively reviewed 32 patients with 66 treated lesions (42 skeletal, 24 non-skeletal) treated between 2012 and 2025. Histology was dichotomized into low-risk (papillary, follicular, medullary, Hürthle cell; n=61) and high-risk (poorly differentiated and squamous cell carcinoma; n=5). BED ₁₀ was calculated using α/β = 10 Gy. LC was defined per RECIST 1.1. Kaplan–Meier and log-rank tests were used. Intra-patient correlation was addressed via generalized estimating equations (GEE) and Cox shared frailty models. A multivariable GEE model included histology risk, site, BED ₁₀ , PTV volume, prior surgery, and age.
Results: Median follow-up was 15.0 months. Six local failures occurred (crude LC 90.9%); 1- and 2-year LC were 96.5% and 87.1%. Histology risk was the dominant determinant: low-risk histology achieved 95.1% crude LC versus 40.0% for high-risk (log-rank p=0.002). In multivariable GEE analysis, low-risk histology was independently associated with LC (OR 158.0, 95% CI 1.72–14,479.7; p=0.028), whereas skeletal site was not (OR 1.07, 95% CI 0.02–51.8; p=0.974). BED ₁₀ was not associated with LC after adjustment (p=0.752). Skeletal and non-skeletal LC were similar after histology stratification (95.0% vs 95.2% among low-risk). Treatment was well tolerated; no Grade ≥3 radiation toxicity, myelopathy, or fractures occurred.
Conclusion: In stereotactic radiation for metastatic non-anaplastic thyroid cancer, histology risk grouping—not anatomic site or dose escalation—is the dominant predictor of local control. These findings support histology-based risk stratification for SRT patient selection.
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BibTeX
@article{gui2026local,
title = {{Local control after stereotactic radiation for thyroid cancer: a histology risk-stratified analysis}},
author = {Bin Gui and Jayavignesh Sekar and Margaret Locke and Shyamali Saha and Mitchell Tulchinsky and Brianna Jones and Nagashree Seetharamu and Maged Ghaly},
journal = {Frontiers in oncology},
year = {2026},
month = sep,
doi = {10.3389/fonc.2026.1898567},
url = {https://europepmc.org/article/PMC/PMC13661363},
note = {CC BY},
}
RIS
TY - JOUR
TI - Local control after stereotactic radiation for thyroid cancer: a histology risk-stratified analysis
AU - Bin Gui
AU - Jayavignesh Sekar
AU - Margaret Locke
AU - Shyamali Saha
AU - Mitchell Tulchinsky
AU - Brianna Jones
AU - Nagashree Seetharamu
AU - Maged Ghaly
PY - 2026
DA - 2026/09/30
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1898567
UR - https://europepmc.org/article/PMC/PMC13661363
AB - Purpose/Objective(s): Recurrent and metastatic non-anaplastic thyroid cancer has traditionally been considered relatively radioresistant. We evaluated whether anatomic site or histology risk group better predicts local control (LC) following stereotactic radiation therapy (SBRT/SRS). Materials/Methods: We retrospectively reviewed 32 patients with 66 treated lesions (42 skeletal, 24 non-skeletal) treated between 2012 and 2025. Histology was dichotomized into low-risk (papillary, follicular, medullary, Hürthle cell; n=61) and high-risk (poorly differentiated and squamous cell carcinoma; n=5). BED ₁₀ was calculated using α/β = 10 Gy. LC was defined per RECIST 1.1. Kaplan–Meier and log-rank tests were used. Intra-patient correlation was addressed via generalized estimating equations (GEE) and Cox shared frailty models. A multivariable GEE model included histology risk, site, BED ₁₀ , PTV volume, prior surgery, and age. Results: Median follow-up was 15.0 months. Six local failures occurred (crude LC 90.9%); 1- and 2-year LC were 96.5% and 87.1%. Histology risk was the dominant determinant: low-risk histology achieved 95.1% crude LC versus 40.0% for high-risk (log-rank p=0.002). In multivariable GEE analysis, low-risk histology was independently associated with LC (OR 158.0, 95% CI 1.72–14,479.7; p=0.028), whereas skeletal site was not (OR 1.07, 95% CI 0.02–51.8; p=0.974). BED ₁₀ was not associated with LC after adjustment (p=0.752). Skeletal and non-skeletal LC were similar after histology stratification (95.0% vs 95.2% among low-risk). Treatment was well tolerated; no Grade ≥3 radiation toxicity, myelopathy, or fractures occurred. Conclusion: In stereotactic radiation for metastatic non-anaplastic thyroid cancer, histology risk grouping—not anatomic site or dose escalation—is the dominant predictor of local control. These findings support histology-based risk stratification for SRT patient selection.
SN - 2234-943X
ER -