Danilovic Debora L S, Castro Gilberto, Roitberg Felipe S R, Vanderlei Felipe A B, Bonani Fernanda A, Freitas Ricardo M C, Coura-Filho George B, Camargo Rosalinda Y, Kulcsar Marco A, Marui Suemi, Hoff Ana O
Endocrinologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil.
Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
Arch Endocrinol Metab. 2018 Jun;62(3):370-375. doi: 10.20945/2359-3997000000046. Epub 2018 May 17.
Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.
全甲状腺切除术、放射性碘（RAI）治疗和促甲状腺激素（TSH）抑制是分化型甲状腺癌（DTC）的主要治疗方法。转移性疾病的治疗包括手术、外照射放疗、RAI以及用于治疗进展性碘难治性疾病的激酶抑制剂。不可切除的局部区域疾病仍然是一个挑战，因为RAI的标准治疗变得不可行。我们报告了一例年轻患者，该患者患有不可切除的乳头状甲状腺癌（PTC），使用索拉非尼治疗后得以进行全甲状腺切除术和RAI治疗。一名20岁男性因颈部肿块增大出现严重呼吸窘迫。影像学检查显示甲状腺多结节肿大、广泛的颈部淋巴结病、严重气管狭窄和肺部微结节。由于该疾病被认为不可切除，他需要紧急手术干预，接受了气管切开术和左侧颈部部分清扫术；病理检查显示为PTC。开始使用索拉非尼治疗，肿瘤显著缩小，从而得以进行近全甲状腺切除术和双侧颈部清扫术。术后，患者对残留气管病变进行了放疗，随后对活跃的颈部和肺部疾病进行了RAI治疗。诊断后4年，患者病情保持稳定。索拉非尼已被批准用于治疗进展性RAI难治性转移性DTC。在本病例报告中，我们描述了一名局部晚期PTC患者，索拉非尼治疗使肿瘤充分缩小，得以进行甲状腺切除术和RAI治疗，提示索拉非尼作为不可切除DTC诱导治疗的潜在作用。
