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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
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Neoadjuvant systemic therapy for inoperable differentiated thyroid cancers: Impact on tumor resectability.

Kylie Dickerson1, Mira Milas1, Rosemarie Metzger1

  • 1Division of Endocrine Surgery, Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ.

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Summary

Neoadjuvant tyrosine kinase inhibitors effectively downstage inoperable differentiated thyroid cancers, enabling successful surgery. This approach improves resectability and patient outcomes in advanced cases.

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Area of Science:

  • Oncology
  • Translational Medicine
  • Surgical Oncology

Background:

  • Limited treatment options for inoperable differentiated thyroid cancers.
  • Investigating neoadjuvant systemic tyrosine kinase inhibitors (TKIs) to facilitate surgery.
  • Addressing the challenge of advanced and unresectable thyroid malignancies.

Purpose of the Study:

  • To evaluate the efficacy of neoadjuvant tyrosine kinase inhibitors in improving surgical resectability of differentiated thyroid cancers.
  • To assess the safety and outcomes of this neoadjuvant approach.
  • To determine the role of genomic profiling in guiding TKI therapy.

Main Methods:

  • Review of 42 patients with thyroid carcinomas treated with TKIs (2018-2023).
  • Focus on 9 patients with differentiated thyroid cancers receiving neoadjuvant TKIs (dabrafenib/trametinib, lenvatinib/pembrolizumab, lenvatinib).
  • Analysis of genomic mutations (BRAF V600E, RAS/TERT, NCOA4-RET) and treatment outcomes.

Main Results:

  • Neoadjuvant TKIs improved resectability in locoregionally advanced thyroid cancers.
  • All patients undergoing surgery achieved R0 resection with no major complications.
  • TKIs were generally well-tolerated, with visible results within weeks.
  • No locoregional recurrence at 2-year median follow-up.

Conclusions:

  • Neoadjuvant TKIs are highly effective for downstaging unresectable differentiated thyroid cancers.
  • Achieving R0 resection and avoiding surgical morbidities is feasible.
  • Multidisciplinary care and genomic profiling are crucial for personalized TKI use.
  • Prospective studies are needed to confirm the role of neoadjuvant TKIs in advanced thyroid cancer.