Surgical treatment of locally advanced papillary thyroid carcinoma after response to lenvatinib: A case report

Tsuboi, Mitsuhiro; Takizawa, Hiromitsu; Aoyama, Mariko; Tangoku, Akira

doi:10.1016/j.ijscr.2017.10.010

Cited by 30 publications

(22 citation statements)

References 9 publications

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“…A group from Japan [14] reported a patient with locally advanced DTC treated with lenvatinib for 22 weeks prior to surgical resection. The primary tumour invaded critical structures in the neck making primary surgery both higher risk and invasive, Therefore, lenvatinib was used to reduce tumour bulk pre-operatively.…”

Section: Discussionmentioning

confidence: 99%

Tyrosine Kinase Inhibitor Therapy in Locally Advanced Differentiated Thyroid Cancer: A Case Report

Stewart¹,

Strachan²,

Srinivasan³

et al. 2019

Eur Thyroid J

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A 73-year-old female presenting with haemoptysis and dyspnoea was found to have a locally advanced left thyroid mass and vocal cord palsy. A CT scan of the neck and thorax and endoscopy demonstrated invasion into the tracheal lumen. Histopathology of the intraluminal tracheal mass confirmed a papillary thyroid cancer (PTC). The tumour was deemed unresectable due to local extent and patient comorbidities. TKI therapy with lenvatinib was used for 14 months. On serial scanning, a marked reduction in tumour volume from 31 × 59 × 32 mm to 17 × 28 × 22 mm was noted. This subsequently allowed a successful surgical resection with a total thyroidectomy and central neck dissection with no evidence of residual macroscopic disease. Histopathology confirmed a well-differentiated PTC with features of tumour regression. In this case, TKI therapy in a locally advanced unresectable DTC reduced tumour size and infiltration to a degree that surgical resection of macroscopic disease was possible, without requiring airway resection. This raises the possibility that TKIs may have a neoadjuvant role in selected cases of locally advanced DTC to reduce tumour volume and therefore morbidity of subsequent surgical resection.

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Section: Discussionmentioning

confidence: 99%

Tyrosine Kinase Inhibitor Therapy in Locally Advanced Differentiated Thyroid Cancer: A Case Report

Stewart¹,

Strachan²,

Srinivasan³

et al. 2019

Eur Thyroid J

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“…Total thyroidectomy was then performed, preserving the patient's esophagus. The patient received radioiodine and did not present evidence of distant metastases at 10 months follow-up after surgery (22).…”

Section: Resultsmentioning

confidence: 99%

Neoadjuvant Multikinase Inhibitor in Patients With Locally Advanced Unresectable Thyroid Carcinoma

et al. 2019

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Background: Papillary thyroid carcinoma (PTC) is the most common and less aggressive thyroid cancer, but some patients may display locally advanced disease. Therapeutic options are limited in these cases, particularly for those patients with unresectable tumors. Neoadjuvant therapy is not part of the recommended work up.Methods: Report a case of an unresectable grossly locally invasive PTC successfully managed with neoadjuvant therapy and provide a systematic review (SR) using the terms “Neoadjuvant therapy” AND “Thyroid carcinoma.”Results: A 32-year-old man with a 7.8 cm (in the largest dimension) PTC was referred to total thyroidectomy, but tumor resection was not feasible due to extensive local invasion (trachea, esophagus, and adjacent structures). Sorafenib, a multikinase inhibitor (MKI), was initiated; a 70% tumor reduction was observed after 6 months, allowing new surgical intervention and complete resection. Radioactive iodine (RAI) was administered as adjuvant therapy, and whole body scan (WBS) shows uptake on thyroid bed. One-year post-surgery the patient is asymptomatic with a status of disease defined as an incomplete biochemical response. The SR retrieved 123 studies on neoadjuvant therapy use in thyroid carcinoma; of them, 6 were extracted: 4 case reports and 2 observational studies. MKIs were used as neoadjuvant therapy in three clinical cases with 70–84% of tumor reduction allowing surgery.Conclusion: Our findings, along with other reports, suggest that MKIs is an effective neoadjuvant therapy and should be considered as a therapeutic strategy for unresectable grossly locally invasive thyroid carcinomas.

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“…Multitargeted TKIs are recently indicated for treatment against radioactive iodine-refractory DTC with excellent prognostic efficacy [1,6]. Recently, TKIs have been reported to have a potential neoadjuvant role in selected cases of locally advanced or unresectable DTC to reduce tumor volume and surgical morbidity [9][10][11][12][13][14][15] as well as in anaplastic thyroid carcinoma [16,17]. However, the neoadjuvant application of TKIs has not been recommended in the current DTC guidelines [1] and is still on debase because of those critical adverse effects such as lethal hemorrhage, or fistula which are caused by rapid tumor shrinkage.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Use of Lenvatinib in Locally Advanced Papillary Thyroid Carcinoma Involving Critical Vessels

Katoh

Kajita

Yokota

et al. 2020

Int. J. Endo. Oncol.

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We report a 65-year old female with advanced papillary thyroid carcinoma involving the critical vessels including common carotid artery (CCA). She initially refused surgery and lenvatinib (LEN) was used in neoadjuvant setting. Primary tumor effectively shrank by LEN without any critical adverse effect. Total thyroidectomy and modified neck dissection were curatively performed. Tumor invading into internal jugular vein exhibited remarkable response to LEN and was almost replaced with necrosis and fibrosis. CCA was surrounded by fibrosis but was smoothly dissected from tumor and preserved. The patient shows no sign of recurrence for 2 years after surgery at present. Neoadjuvant LEN treatment can be new option for locally advanced papillary thyroid carcinoma involving critical vessels, particularly CCA, to reduce risk of surgical morbidity.

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Surgical treatment of locally advanced papillary thyroid carcinoma after response to lenvatinib: A case report

Abstract: HighlightsThere is no established neoadjuvant therapy for advanced DTC.We report the case of a locally advanced DTC that was invaded the trachea, the muscular layer of the esophagus, and the right internal jugular vein.After response to lenvatinib, the tumor was resected.

Cited by 30 publications

References 9 publications

Tyrosine Kinase Inhibitor Therapy in Locally Advanced Differentiated Thyroid Cancer: A Case Report

Tyrosine Kinase Inhibitor Therapy in Locally Advanced Differentiated Thyroid Cancer: A Case Report

Neoadjuvant Multikinase Inhibitor in Patients With Locally Advanced Unresectable Thyroid Carcinoma

Neoadjuvant Use of Lenvatinib in Locally Advanced Papillary Thyroid Carcinoma Involving Critical Vessels

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