1
|
Alam IS, Patel KN. Management of Poorly Differentiated Thyroid Cancer and Differentiated High-Grade Thyroid Carcinoma. Surg Clin North Am 2024; 104:751-765. [PMID: 38944496 DOI: 10.1016/j.suc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Thyroid carcinoma of follicular cell origin exists on a histopathologic and clinical spectrum. The authors focus on the category of tumors that fall between the very favorable well-differentiated thyroid carcinomas and the very unfavorable anaplastic thyroid carcinomas. These intermediately aggressive tumors include poorly differentiated thyroid carcinoma and the newly defined differentiated high-grade thyroid carcinoma. Both diagnoses require certain histopathologic requirements be met in order to accurately identify these tumors post-operatively. Management remains primarily surgical though adjunctive treatments such as molecular targeted therapies (eg, tyrosine kinase inhibitors) and differentiation therapy (to restore tumor response to radioactive iodine) are also becoming available.
Collapse
Affiliation(s)
- Iram S Alam
- Department of Surgery, NYU Langone Health, 530 First Avenue, 12th Floor, New York, NY 10016, USA.
| | - Kepal N Patel
- Faculty Development, Division of Endocrine Surgery, NYU Langone Health, 530 First Avenue, 12th Floor, New York, NY 10016, USA
| |
Collapse
|
2
|
Violetis O, Konstantakou P, Spyroglou A, Xydakis A, Kekis PB, Tseleni S, Kolomodi D, Konstadoulakis M, Mastorakos G, Theochari M, Aller J, Alexandraki KI. The Long Journey towards Personalized Targeted Therapy in Poorly Differentiated Thyroid Carcinoma (PDTC): A Case Report and Systematic Review. J Pers Med 2024; 14:654. [PMID: 38929875 PMCID: PMC11205159 DOI: 10.3390/jpm14060654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Poorly differentiated thyroid carcinoma (PDTC) has an intermediate prognosis between indolent well-differentiated thyroid carcinoma (TC) and anaplastic carcinoma. Herein, we present a case report with a PDTC component, along with a systematic review of the literature. CASE REPORT We report a case of a 45-year-old man diagnosed with a PDTC component, along with hobnail and tall-cell variant features positive for BRAFV600E mutation, after a total thyroidectomy and neck dissection. Radioactive iodine (RAI)-131 therapy was applied, but an early recurrence led to complementary surgeries. The anti-Tg rise, the presence of new lymph nodes, and the negative whole-bodyradioiodine scan were suggestive of a radioiodine-resistant tumor. Lenvatinib, sorafenib, dabrafenib/trametinib, cabozantinib and radiotherapy were all administered, controlling the tumor for a period of time before the patient ultimately died post-COVID infection. Systematic Review: We searched PubMed, Scopus, and WebofScience to identify studies reporting clinicopathological characteristics, molecular marker expression, and management of non-anaplastic TC with any proportion of PDTC in adult patients. Of the 2007 records retrieved, 82were included in our review (PROSPERO-ID545847). CONCLUSIONS Our case, together with the systematic review, imply that a combination of molecular-targetedtreatments may be safe and effective in patients with RAI-resistantBRAF-mutated advanced PDTC when surgery has failed to control tumor progression.
Collapse
Affiliation(s)
- Odysseas Violetis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Panagiota Konstantakou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Ariadni Spyroglou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Antonios Xydakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | | | - Sofia Tseleni
- Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Denise Kolomodi
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Ekpa-Laiko Center, 11527 Athens, Greece;
- IATROPOLIS Private Medical Center, 11521 Athens, Greece
| | - Manousos Konstadoulakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - George Mastorakos
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Maria Theochari
- Department of Oncology, Ippokrateio Athens General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Javier Aller
- Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Krystallenia I. Alexandraki
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| |
Collapse
|
3
|
Yamazaki H, Sugino K, Katoh R, Matsuzu K, Masaki C, Akaishi J, Hames KY, Tomoda C, Suzuki A, Ohkuwa K, Kitagawa W, Nagahama M, Rino Y, Ito K. Response to neoadjuvant paclitaxel predicts survival in anaplastic thyroid carcinoma. Cancer Med 2022; 12:3027-3035. [PMID: 36052510 PMCID: PMC9939216 DOI: 10.1002/cam4.5219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/25/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
The clinical utilities of paclitaxel in anaplastic thyroid carcinoma (ATC) have been reported. The current study investigated the outcomes in ATC patients treated by paclitaxel as neoadjuvant setting. Furthermore, the prognostic factor for overall survival (OS) and predictive marker for response to paclitaxel were investigated. Records of ATC patients treated by paclitaxel as neoadjuvant setting in our hospital were reviewed. The median OS for the patients with (n = 43) and without (n = 23) resection were 14.7 (95% CI, 11.0-21.7) and 4.2 (95% CI, 3.0-5.4) months, respectively (p < 0.001). Univariate analysis identified the factors of stage (p = 0.028), prognostic index (PI) ≥2 (p < 0.001), response to paclitaxel (p = 0.007), resection (p < 0.001), and radiotherapy (p < 0.001) to be associated with OS, and multivariate analysis revealed that the factors of PI ≥2 [hazard ratio (HR), 2.406 (95% CI, 1.096-5.281), p = 0.029], response to paclitaxel [HR, 0.423 (95% CI, 0.193-0.930), p = 0.032], resection [HR, 0.316 (95% CI, 0.129-0.773), p = 0.012], and radiotherapy [HR, 0.229 (95% CI, 0.100-0.526), p < 0.001] were independent prognostic factors of OS. There were no significant predictive factors for response to paclitaxel in baseline characteristics. PI ≥2, response to paclitaxel, resection, and radiotherapy were independent prognostic factors in ATC patients treated with paclitaxel as neoadjuvant setting. It is important to investigate predictor for response to paclitaxel for improving resectability and prognosis in ATC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yasushi Rino
- Department of SurgeryYokohama City University School of MedicineYokohamaJapan
| | - Koichi Ito
- Department of SurgeryIto HospitalTokyoJapan
| |
Collapse
|
4
|
Tong J, Ruan M, Jin Y, Fu H, Cheng L, Luo Q, Liu Z, Lv Z, Chen L. Poorly differentiated thyroid carcinoma: a clinician's perspective. Eur Thyroid J 2022; 11:e220021. [PMID: 35195082 PMCID: PMC9010806 DOI: 10.1530/etj-22-0021] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is a rare thyroid carcinoma originating from follicular epithelial cells. No explicit consensus can be achieved to date due to sparse clinical data, potentially compromising the outcomes of patients. In this comprehensive review from a clinician's perspective, the epidemiology and prognosis are described, diagnosis based on manifestations, pathology, and medical imaging are discussed, and both traditional and emerging therapeutics are addressed as well. Turin consensus remains the mainstay diagnostic criteria for PDTC, and individualized assessments are decisive for treatment option. The prognosis is optimal if complete resection is performed at early stage but dismal in nearly half of patients with locally advanced and/or distant metastatic diseases, in which adjuvant therapies such as 131I therapy, external beam radiation therapy, and chemotherapy should be incorporated. Emerging therapeutics including molecular targeted therapy, differentiation therapy, and immunotherapy deserve further investigations to improve the prognosis of PDTC patients with advanced disease.
Collapse
Affiliation(s)
- Junyu Tong
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Qiong Luo
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zhiyan Liu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| |
Collapse
|
5
|
Alshehri K, Alqurashi Y, Merdad M, Samargandy S, Daghistani R, Marzouki H. Neoadjuvant lenvatinib for inoperable thyroid cancer: A case report and literature review. Cancer Rep (Hoboken) 2021; 5:e1466. [PMID: 34105309 PMCID: PMC8842697 DOI: 10.1002/cnr2.1466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Poorly differentiated thyroid cancer (PDTC) is now classified as a separate thyroid tumor entity. It has male predominance and poor prognosis compared to differentiated TC. Case We report a case of a patient with PDTC who was previously deemed inoperable. A trial of neoadjuvant lenvatinib therapy was given to the patient after that the tumor become operable and the surgery went successfully. Conclusions Lenvatinib is a feasible option in patients with inoperable TC and can stabilize the lesion size or even reduce it, leading to a more favorable surgical outcome.
Collapse
Affiliation(s)
- Khalid Alshehri
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Yousuf Alqurashi
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mazin Merdad
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Shaza Samargandy
- Endocrine Unite, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Razan Daghistani
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hani Marzouki
- Department of Otorhinolaryngology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
6
|
Zhang Y, Deng X, Ding Z, Kang J, Wu B, Guo B, Fan Y. Preoperative neoadjuvant targeted therapy with apatinib for inoperable differentiated thyroid cancer: A case report. Medicine (Baltimore) 2021; 100:e25191. [PMID: 33761701 PMCID: PMC9281949 DOI: 10.1097/md.0000000000025191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Though the majority of differentiated thyroid cancer (DTC) patients have a good prognosis after careful and standardized therapy, approximately 13% to 15% of DTC cases show surprisingly aggressive behavior and invasion of the surrounding structures, and a few progress to unresectable diseases. In this study, we report a case of an inoperable locally advanced DTC patient who underwent a curative operation after treatment of preoperative monotherapy of apatinib in a short time. PATIENT CONCERNS A 64-year-old woman complained of dysphagia due to large cervical mass, which severely invaded the left esophagus at the junction of the neck and thorax. DIAGNOSES The female patient was diagnosed with locally advanced papillary thyroid cancer (PTC) by cytopathology and it was difficult to perform a safe and complete removal. INTERVENTIONS Apatinib (500 mg orally once a day) was initially used to treat this patient as a neoadjuvant therapy. OUTCOMES Six weeks later, the tumor dramatically shrunk from 56 × 37 mm to 29 × 26 mm with well-controlled mild hypertension. After a 10-day interval of apatinib withdrawal, complete tumor excision was accomplished through cervical incision without esophageal fistula. Postoperative thyroid stimulating hormone suppression and radioiodine 131I ablation therapy were performed. At the 1-year follow-up evaluation, no tumor recurrence or metastasis was observed. LESSONS Preoperative short term targeted treatment with apatinib for locally advanced inoperable DTC may become a promising neoadjuvant therapy that, can reduce the tumor size and decrease stage, thus making the complete and safe removal of the lesion feasible.
Collapse
Affiliation(s)
- Yingchao Zhang
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Xianzhao Deng
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Zheng Ding
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Kang
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Bo Wu
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Bomin Guo
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Youben Fan
- Center of Thyroid and Parathyroid, Department of Thyroid-breast-hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| |
Collapse
|
7
|
Katoh H, Kajita S, Yokota M, Sengoku N, Sangai T. Neoadjuvant use of lenvatinib in locally advanced papillary thyroid carcinoma involving critical vessels. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2020. [DOI: 10.2217/ije-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Hiroshi Katoh
- Department of Breast & Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Sabine Kajita
- Department of Pathology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Mitsuo Yokota
- Department of Breast & Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Norihiko Sengoku
- Department of Breast & Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Takafumi Sangai
- Department of Breast & Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| |
Collapse
|