Local control after stereotactic radiation for thyroid cancer: a histology risk-stratified analysis.

Authors

Bin Gui, Jayavignesh Sekar, Margaret Locke, Shyamali Saha, Mitchell Tulchinsky, Brianna Jones, Nagashree Seetharamu, Maged Ghaly

Published in

Frontiers in oncology. Volume 16. Pages 1898567. Epub Sep 30, 2026.

Abstract

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).
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). BED₁₀ 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, BED₁₀, PTV volume, prior surgery, and age.
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). BED₁₀ 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.
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.

PMID:
42876475
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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