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Updated: Jun 9, 2025
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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
483
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.
Surgery
|October 29, 2024
Summary
Neoadjuvant tyrosine kinase inhibitors effectively downstage inoperable differentiated thyroid cancers, enabling successful surgery. This approach improves resectability and patient outcomes in advanced cases.
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.
