Case of papillary thyroid cancer presenting with an inoperable cervical mass successfully treated with high-dose radiation therapy.

External-beam radiation therapy (EBRT) for differentiated thyroid cancer has been controversial. Palliative irradiation is usually recommended for patients with treatment-resistant relapse and/or distant metastases, but high-dose EBRT is not often indicated in this situation. A 50-year-old man had treatment-resistant recurrence of an inoperable cervical mass and multiple lung metastases after total thyroidectomy and neck dissection. Because the patient had good performance status and no other life-threatening metastases, he received high-dose intensity-modulated radiation therapy (IMRT). Remarkably, the tumour shrank during treatment. After 3 months, he had bleeding from the internal carotid artery. The bleeding was outside the high-dose irradiation site and was likely due to infection; emergency interventional radiology was performed. The post-EBRT clinical course was favourable and the cervical mass almost disappeared. The patient remained alive for 3 years post treatment. It is possible to extend the indication of high-dose intensity-IMRT in selected patients with differentiated thyroid cancer.