Neoadjuvant tyrosine kinase inhibitor therapy for locally advanced, well-differentiated thyroid cancer

Locally advanced, well-differentiated thyroid cancer presents a surgical challenge, particularly when tumours involve the airway or other critical structures. Neoadjuvant tyrosine kinase inhibitors (TKIs) may downsize disease and improve operability, but evidence remains limited. This study reports oncological and surgical outcomes following neoadjuvant TKI therapy in a single-centre cohort.

A retrospective cohort study was conducted of patients with locally advanced, well-differentiated thyroid cancer treated with pre-operative TKI therapy between 2016 and 2025. Clinical outcomes, surgical aims and procedures, complications, recurrence, and survival were recorded. Tumour volume reduction was assessed radiologically.

Nine patients were included (median age 60 years; 78% female). All had T4a disease, and 3 had pulmonary metastases. Median TKI duration was 7 months. Most patients experienced grade 1-2 adverse effects; 3 developed grade 3-4 toxicity. Tumour volume reduction occurred predominantly within the first 3-6 months, with continued regression up to 18 months. Primary surgical aims were achieved in 89%, including successful conversion of unresectable disease to resectable and avoidance of laryngectomy in all 4 patients for whom it was initially indicated. After a median 44-month follow-up, 5-year recurrence-free and disease-specific survival were both 89%; one patient with metastatic disease died during follow-up and no patient developed uncontrolled central neck disease.

Neoadjuvant TKI therapy facilitated surgical management and reduced the need for morbid airway surgery in selected patients with locally advanced, well-differentiated thyroid cancer. These findings support its use within multidisciplinary pathways, although prospective studies are needed to refine patient selection and treatment duration.