Lenvatinib as Neoadjuvant Therapy in Locally Advanced Thyroid Cancer: CT-Based Selection and Outcomes From a
J J Santivañez1, C Betancourt1,2,3,4, C García1,3,4
1Head and Neck Surgery Section, University of Antioquia, Medellin, Colombia.
Head & Neck
|March 5, 2026
Summary
Neoadjuvant lenvatinib improved surgical outcomes for locally advanced thyroid cancer (LATC) by enabling resectability and de-escalation in selected patients. Computed tomography (CT)-based complexity scores aided in patient selection for this approach.
Area of Science:
- Oncology
- Endocrinology
- Surgical Oncology
Background:
- Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy, with increasing incidence.
- Locally advanced thyroid carcinoma (LATC) presents challenges in surgical management due to unresectability or high morbidity.
- Lenvatinib shows promise as neoadjuvant therapy for radioiodine-refractory DTC, potentially facilitating surgery.
Purpose of the Study:
- To evaluate lenvatinib's role as neoadjuvant therapy in locally advanced or recurrent DTC.
- To assess lenvatinib's ability to achieve resectability or surgical de-escalation.
- To determine the utility of CT-based anatomical complexity scores for patient selection.
Main Methods:
- Retrospective study of 23 patients with LATC treated with neoadjuvant lenvatinib.
- Patients classified as unresectable (n=12) or requiring major surgery (RMS, n=11) based on pretreatment CT.
- Disease complexity assessed using MMM and TNMC scores; radiologic response evaluated by RECIST 1.1.
Main Results:
- Partial or complete radiologic response achieved in 69% of patients (16/23).
- Surgery was performed in 56% (13/23), with complete resection in 86% of initially unresectable cases.
- Surgical de-escalation achieved in 83% of RMS cases, avoiding major procedures; R0/R1 margins in 85% of operated patients.
Conclusions:
- Neoadjuvant lenvatinib facilitated conversion to resectability and surgical de-escalation in selected LATC patients.
- CT-based complexity scores proved valuable for selecting appropriate patients.
- Further prospective studies are needed to refine indications and treatment duration.
