Hartl Dana M, Bani Mohamed-Amine, Ghuzlan Abir Al, Simonescu Andreea-Elena, Breuskin Ingrid, Marhic Alix, Albiges Laurence, Lamartina Livia, Hadoux Julien
Division of Surgery and Anesthesiology, Head and Neck Oncology Service, Thyroid Surgery Unit, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France.
Front Oncol. 2025 May 28;15:1543060. doi: 10.3389/fonc.2025.1543060. eCollection 2025.
Neoadjuvant therapy is under investigation not only for unresectable clear cell renal cell carcinoma (ccRCC) (1) but also for locally invasive primary thyroid cancers (2). Herein, we describe two cases of locally invasive thyroid metastases from ccRCC treated surgically after neoadjuvant therapy to highlight the rationale and outcomes.
Two patients, one woman and one man, both age 69, developed unresectable thyroid metastases from ccRCC, respectively, 20 and 13 years after nephrectomy for ccRCC. Patient 1 received lenvatinib and a bispecific anti-Programmed cell Death protein 1/ cytotoxic T-lymphocyte-associated protein 4 (PD-1/CTLA-4) antibody in the context of a clinical trial. The second patient received nivolumab and cabozantinib.
The observed tumor response in patient 1 showed a decrease in mean surgical complexity score from unresectable (prevertebral fascia invasion) to severe (risk of recurrent nerve paralysis) and in patient 2 from unresectable (prevertebral fascia) to moderate (superficial esophageal invasion). The recurrent nerve was invaded in patient 1, leading to a subtotal resection. Surgery was a total thyroidectomy extended to the internal jugular vein in patient 2. Hospitalization was 1 and 2 days, respectively. Postoperative dysphonia improved in patient 1 after 3 months. No complications occurred in the second patient, who received adjuvant radiation therapy. After surgery, systemic therapy was discontinued in both patients, and stable residual oligometastatic disease was followed.
Neoadjuvant therapy enabled a macroscopic resection of locally invasive thyroid metastases, preserving laryngeal function and allowing discontinuation of systemic therapy. This approach may be considered in these rare cases, although the impact on progression-free or overall survival is currently unknown.
新辅助治疗不仅正在研究用于不可切除的透明细胞肾细胞癌（ccRCC）（1），也用于局部侵袭性原发性甲状腺癌（2）。在此，我们描述两例经新辅助治疗后手术治疗的ccRCC局部侵袭性甲状腺转移病例，以突出其基本原理和结果。
两名患者，一名女性和一名男性，均为69岁，分别在ccRCC肾切除术后20年和13年出现不可切除的ccRCC甲状腺转移。患者1在一项临床试验中接受了乐伐替尼和一种双特异性抗程序性细胞死亡蛋白1/细胞毒性T淋巴细胞相关蛋白4（PD-1/CTLA-4）抗体治疗。第二名患者接受了纳武单抗和卡博替尼治疗。
患者1观察到的肿瘤反应显示，平均手术复杂程度评分从不可切除（椎前筋膜侵犯）降至严重（喉返神经麻痹风险），患者2从不可切除（椎前筋膜）降至中度（食管浅层侵犯）。患者1的喉返神经受侵，导致次全切除。患者2的手术为全甲状腺切除术并延伸至颈内静脉。住院时间分别为1天和2天。患者1术后3个月声音嘶哑情况改善。第二名接受辅助放疗的患者未发生并发症。手术后，两名患者均停止全身治疗，并对稳定的残留寡转移疾病进行随访。
新辅助治疗能够对局部侵袭性甲状腺转移灶进行宏观切除，保留喉功能并允许停止全身治疗。在这些罕见病例中可考虑采用这种方法，尽管目前对无进展生存期或总生存期的影响尚不清楚。
