Citation: Thyroid. 29(7):971-978, 2019 Jul..Journal: Thyroid : official journal of the American Thyroid Association.Published: ; 2019ISSN: 1050-7256.Full author list: Wu D; Gomes Lima CJ; Moreau SL; Kulkarni K; Zeymo A; Burman KD; Wartofsky L; Van Nostrand D.UI/PMID: 31017051.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/Endocrinology | Medicine/Nuclear MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1089/thy.2018.0582 (Click here)Abbreviated citation: Thyroid. 29(7):971-978, 2019 Jul.Local Holdings: Available online from MWHC library: August 2000 - present, Available in print through MWHC library: 1999 - 2006.Abstract: <b>Background:</b> The objective of this study was to evaluate the overall survival (OS) of radioiodine (<sup>131</sup>I) treatments alone or combined with non-<sup>131</sup>I treatments in patients with bone metastases (BM) of differentiated thyroid cancer (DTC). <b>Methods:</b> This was a retrospective study of patients who were evaluated between 2001 and 2018 at MedStar Washington Hospital Center and who had DTC, BM, and at least one <sup>131</sup>I treatment after the diagnosis of BM. The OS was analyzed by Kaplan-Meier survival curves and was compared by log-rank test between two groups: patients who received <sup>131</sup>I treatments alone and those who received treatments combining <sup>131</sup>I with non-<sup>131</sup>I treatments (CombTx). Non-<sup>131</sup>I treatments include surgery, radiofrequency ablation, cryotherapy, arterial embolization, external beam radiation, Cyberknife, systemic targeted therapy, and anti-resorptive medication. <b>Results:</b> A total of 77 patients met the above criteria and were followed up to 41 years. Thirty percent (23/77) of patients received <sup>131</sup>I treatment alone, and 70% (54/77) received CombTx. For <sup>131</sup>I treatment alone, the median survival was 3.9 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 86%, 81%, 61%, 35%, and 23%, respectively. For CombTx, the median survival was 7.7 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 96%, 92%, 86%, 69%, and 30%, respectively. Patients who had undergone initial <sup>131</sup>I therapy within six months post thyroidectomy demonstrated a better median survival after BM diagnosis than those whose initial <sup>131</sup>I therapy was six months or more after thyroidectomy (6.5 vs. 0.5 years; p < 0.001). Patients who received external beam radiation therapy demonstrated a better median survival than those who did not (7.8 vs. 4.4 years; p = 0.016). Patients who received denosumab demonstrated a better median survival than those who did not (7.7 vs. 5.2 years; p = 0.03). Patients who were <55 years of age at the initial diagnosis of DTC or at the initial diagnosis of BM had a better median OS than those diagnosed at >=55 years of age (both p = 0.01). In the multivariate analysis, only age at initial diagnosis of DTC and initial <sup>131</sup>I therapy within six months post thyroidectomy, and multiple <sup>131</sup>I treatments were independent prognostic factors. <b>Conclusions:</b> In patients with DTC with BM, <sup>131</sup>I treatment in combination with one or more non-<sup>131</sup>I direct and systemic treatments was associated with a significant increase in OS compared with those patients who were treated by <sup>131</sup>I treatment alone.