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.
Background:
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy and its incidence has increased in recent decades. In locally advanced thyroid carcinoma (LATC), disease may be unresectable or require highly morbid surgical procedures. Lenvatinib has demonstrated rapid tumor shrinkage in radioiodine-refractory DTC, suggesting a potential role as neoadjuvant therapy to facilitate surgical management. However, optimal patient selection for this approach remains unclear. We evaluated the role of lenvatinib as neoadjuvant therapy to achieve resectability or surgical de-escalation in patients with locally advanced or recurrent DTC, using computed tomography (CT)-based anatomical complexity scores for patient selection.
Methods:
A retrospective study was conducted in 23 patients with locally advanced or recurrent DTC treated with neoadjuvant lenvatinib at a tertiary referral center. Based on pretreatment CT findings, patients were classified as unresectable (n = 12) or resectable only through major surgery (RMS) (n = 11). Disease complexity was assessed using the MMM surgical morbidity and complexity score and the thyroid neck morbidity and complexity (TNMC) classification. Radiologic response was evaluated according to RECIST 1.1 criteria.
Results:
Median lenvatinib treatment duration was 10 months (range 2-25). Partial or complete radiologic response was achieved in 16 patients (69%). Surgery was performed in 13 patients (56%): 7/12 (58%) from the initially unresectable group and 6/11 (55%) from the RMS group. Among unresectable cases undergoing surgery, complete resection was achieved in 6/7 (86%). In the RMS group, surgical de-escalation was achieved in 5/6 (83%), avoiding procedures such as laryngectomy or pharyngolaryngectomy. Overall, R0/R1 margins were obtained in 11/13 operated patients (85%). The 24-month overall survival was 89.7%, and treatment was generally well tolerated.
Conclusions:
Neoadjuvant lenvatinib enabled conversion to resectability and meaningful surgical de-escalation in selected patients with LATC, with acceptable toxicity. CT-based complexity scores were useful tools for patient selection. Prospective multicenter studies integrating molecular profiling are needed to refine indications and optimal treatment duration.
