A Case of Unresectable Papillary Thyroid Carcinoma Treated with Lenvatinib as Neoadjuvant Chemotherapy

Abstract

A 75-year-old woman visited a nearby clinic with complaints of right clavicle discomfort, and she underwent diagnostic thoracoscopic lung biopsy, being diagnosed with lung metastasis and a right-upper mediastinal mass. The superior mediastinum mass was extrapulmonary and covered by the pleura, and it was not biopsied. Papillary thyroid carcinoma was diagnosed following biopsy of the lung metastasis. Only a small tumor, with a maximum diameter of 70 mm from the right neck to the superior mediastinum, in the thyroid gland invades the internal jugular vein and subclavian vein, forming a tumor embolus in the right brachiocephalic vein and reaching the vicinity of the superior vena cava. For life-saving purposes, we obtained approval from the Cancer Board of Kanagawa Cancer Center and used lenvatinib according to unresectable undifferentiated cancer IRB approval number 28–41. The tumor had shrunk after 4 months, and surgery was performed. The postoperative course has been good, and the patient is being followed up. The patient is alive three months after surgery, and lung metastases have disappeared on CT images. This case is reported as a successful case of neoadjuvant chemotherapy and interval debulking surgery.

Invasive procedures in patients undergoing treatment with lenvatinib for thyroid cancer

“…Meanwhile, total thyroidectomy with resection of the upper mediastinal tumor was performed in a 75-year-old woman. In this case ( 13 ), which we had reported previously, the tumor had invaded the internal jugular and subclavian veins, forming a tumor embolus in the right brachiocephalic vein and reaching the vicinity of the superior vena cava. In addition, for life-saving purposes, we used lenvatinib.…”

Neoadjuvant lenvatinib for inoperable thyroid cancer: A case report and literature review

“…Table 1 presents a series of TC case reports that employed neoadjuvant TKI therapy and their subsequent outcomes. [11][12][13][14][15][16][17][18] Two of these cases had recurrent locally invasive TC, 12,17 and the other cases were newly diagnosed with advanced TC. The tumor size in the series ranged between 4 and 8 cm, with an effect that was observed after a short period of 8 weeks and as long as 98 weeks.…”

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

“…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.…”