Riker Adam I, Hodgdon Ian A, Dewenter Tracy A, Marshall Richard, Boulmay Brian
Anne Arundel Medical Center, Geaton and JoAnn DeCesaris Cancer Institute, Department of Surgery, Cancer Service Line, Luminis Health, Annapolis, MD.
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner J. 2021 Summer;21(2):224-229. doi: 10.31486/toj.20.0067.
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. 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. A multimodal, comprehensive approach to managing such complex patients is essential to optimize both the sequence and therapeutic approach to treatment.
分化型甲状腺癌（DTC）由乳头状和滤泡状亚型组成，两者总体长期预后良好。局限性DTC患者经成功治疗（通常为手术治疗）后，长期生存率通常远高于90%。相比之下，发生远处转移性疾病的患者总体预后和结局明显较差，其疾病往往对手术、放射性碘和激素抑制等传统治疗方法难治。对于复发并伴有远处转移性疾病的患者，有效的治疗选择有限，大多数患者在复发后5年内死于该疾病。我们报告了一例26岁女性患者，她患有复发性乳头状甲状腺癌且肝脏有孤立性转移病灶。由于初次就诊时转移性肝肿块极大，我们采取了新辅助、多方面的治疗方法，包括选择性肝内放射栓塞治疗、口服多激酶抑制剂以及在肿瘤大小最大程度缩小后对肿瘤肿块进行手术切除。然而，该患者在治疗39个月后死于转移性DTC。对于管理此类复杂患者，采用多模式、综合的方法对于优化治疗顺序和治疗方法至关重要。
