Int J Thyroidol.  2015 Nov;8(2):198-203. 10.11106/ijt.2015.8.2.198.

A Case of Adjuvant Treatment with Sorafenib after Radiotherapy for Brain Metastasis from Poorly Differentiated Thyroid Carcinoma

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea. ldj6026@catholic.ac.kr
  • 2Department of Radiation Oncology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
  • 3Department of Hospital Pathology, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Abstract

Sorafenib is an emerging therapeutic option for radioactive iodine (RAI)-refractory differentiated thyroid carcinoma. However, the effects of sorafenib as an adjuvant treatment following surgery or radiation on brain metastases from poorly differentiated thyroid carcinoma (PDTC) have never been reported. A 52-year-old patient underwent total thyroidectomy for follicular thyroid carcinoma. Despite high-dose RAI therapy, a neck mass and lung metastases were developed. PDTC was diagnosed by neck mass removal. During adjuvant external beam radiation therapy (EBRT) to the neck, brain metastases developed. After palliative EBRT for brain metastases, the brain tumor size decreased but lung metastases markedly progressed. Off-label sorafenib was used to treat progressive multiple metastatic lesions. Over five months of sorafenib treatment, the sum of the longest diameters for target lesions was decreased by 45% in brain and 13% in lung. Sorafenib can be considered a new adjuvant therapeutic option for metastatic brain lesions from PDTC after EBRT.

Keyword

Thyroid carcinoma; Brain; Sorafenib

MeSH Terms

Adenocarcinoma, Follicular
Brain Neoplasms
Brain*
Humans
Iodine
Lung
Middle Aged
Neck
Neoplasm Metastasis*
Radiotherapy*
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Iodine

Figure

  • Fig. 1. Microscopic imaging of anterior neck mass. (A) The tumor shows a solid trabecular growth pattern and frequent necrosis (N) (H-E stain, ×40). (B) The tumor cells are monotonous and show small round nuclei with dark chromatin and frequent mitoses (arrows) (H-E stain, ×40).

  • Fig. 2. Radiologic imaging of brain. (A) Brain metastases were diagnosed by MR ima-ging, showing a 3.8×4.4 cm mass with central necrosis in the right frontal lobe. (B) Shortly after EBRT for brain metastases. The dimensions of the mass had decreased to 3.8×2.7 cm. (C) Five mo-nths after sorafenib treat-ment. Brain CT showed de-crease in size of the mass (2.0×1.5 cm). (D) Two mon-ths after sorafenib disconti-nuation. Brain MRI showed marked progression of the mass (5.4×3.7 cm).

  • Fig. 3. CT scan of the chest.(A) At the end of EBRT on thyroid bed. Chest CT ima-ges showed multiple meta-static nodules in both lungs. (B) Five months after sora-fenib initiation. Sum of the longest diameters of two no-dules decreased by 13%. (C) At the end of EBRT on thy-roid bed. Chest CT images showed no mediastinal lym-ph node enlargement. (D) Five months after sorafenib initiation. Mediastinal lymph nodes were extensively en-larged.

  • Fig. 4. Clinical course. Neck mass excision, EBRT on neck and brain, and sorafenib therapy were performed. Line graphs show time course of suppressed serum thyroglobulin (Tg) level (black line) and the diameter of metastatic brain lesion (grey line).


Reference

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