Metastatic Papillary Thyroid Cancer to the Liver: The Central Role of a Multidisciplinary Approach to Treatment

Abstract

Background: Differentiated thyroid cancer (DTC) is comprised of papillary and follicular subtypes, and both have an overall excellent long-term prognosis. Patients with localized DTC that is successfully treated, usually with surgery, exhibit long-term survival well above 90%. In contrast, patients who develop distant metastatic disease have a significantly worse overall prognosis and outcome, often with disease that is refractory to conventional therapy such as surgery, radioactive iodine, and hormone suppression. For patients who recur with distant metastatic disease, limited effective treatment options are available, and most die of their disease within 5 years of recurrence. Case Report: We report the case of a 26-year-old female who presented with recurrent papillary thyroid cancer and a metastatic lesion isolated to the liver. Because of the extremely large size of the metastatic liver mass upon initial presentation, we took a neoadjuvant, multifaceted approach to treatment that included selective internal radioembolization therapy, an oral multikinase inhibitor, and surgical resection of the tumor mass after maximal reduction in tumor size. However, the patient died of metastatic DTC after 39 months of treatment. Conclusion: A multimodal, comprehensive approach to managing such complex patients is essential to optimize both the sequence and therapeutic approach to treatment.

Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report

“…The serum levels of CA19-9 in previously reported patients with liver metastasis of PTC were normal in one patient and not described in 4 patients [3][4][5][6][7]. Since serum levels of CA19-9 are not usually measured in patients with PTC, the percentage of elevated serum CA19-9 levels in patients with PTC is not known.…”

“…The major sites of distant metastases from PTC are the lung and bone. However, to date, there have been few reports of liver metastases in patients with PTC [1][2][3][4][5][6][7]. As liver metastases are usually found along with other distant metastases sites and are nearly always multiple or diffuse [7], it is even more unusual to encounter isolated resectable liver metastases from PTC.…”

A case of papillary thyroid carcinoma with renal and pulmonary metastases

“…The first treatment for the recurrence and distant metastasis of DTC is generally RAI therapy. Riker reported that lenvatinib was used as initial treatment for a patient with advanced liver metastasis of thyroid papillary cancer liver metastasis before thyroidectomy and RAI [ 7 ]. Depending on the condition of distant metastatic organs, TKI treatment before RAI may be effect to obtain good disease control.…”

A systematic review of neoadjuvant targeted therapy in locally advanced thyroid cancer

“…The patient then developed multiple bone metastasis at 33 months and died. The full clinical course and treatment was approximately 39 months [13]. All 3 MTC patients remained recurrence-free at follow-up.…”