This protocol applies to patients with Multiple endocrine neoplasia type 2B (MEN2B) who have medullary thyroid carcinoma (MTC) complicated by painful bone metastases, or by fractures and impending fractures.

Clinical Scenario

Skeletal involvement in this setting — including painful osseous metastases and established or threatened fractures — represents a distinct management challenge. Both pain control and prevention of further skeletal complications are central concerns in this population.

Approach Overview

For painful bone metastases, bone-modifying agents are a key component of care. Fractures and impending fractures call for additional local or procedural interventions — the full structured regimen specifies which options apply, and how they are sequenced.

References

DOI: 10.1089/thy.2014.0335

Treatment with denosumab or bisphosphonates is recommended for patients with painful osseous metastases.

Treatment with either intravenous bisphosphonates (zoledronic acid or pamidronate) or the receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor, denosumab, in patients with thyroid cancer has been effective in relieving pain from bony metastases and in preventing or delaying the occurrence of other skeletal related events.

Patients with MTC who have fractures or impending fractures require treatment. Therapeutic options include surgery, thermoablation (radiofrequency or cryotherapy), cement injection, and EBRT.

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MEN2B in Medullary Thyroid Carcinoma with Painful Bone Metastases

References