Preoperative neoadjuvant targeted therapy with apatinib for inoperable differentiated thyroid cancer A case report

Rationale: Though the majority of differentiated thyroid cancer (DTC) patients have a good prognosis after careful and standardized therapy, approximately 13% to 15% of DTC cases show surprisingly aggressive behavior and invasion of the surrounding structures, and a few progress to unresectable diseases. In this study, we report a case of an inoperable locally advanced DTC patient who underwent a curative operation after treatment of preoperative monotherapy of apatinib in a short time. Patient concerns: A 64-year-old woman complained of dysphagia due to large cervical mass, which severely invaded the left esophagus at the junction of the neck and thorax. Diagnoses: The female patient was diagnosed with locally advanced papillary thyroid cancer (PTC) by cytopathology and it was difficult to perform a safe and complete removal. Interventions: Apatinib (500 mg orally once a day) was initially used to treat this patient as a neoadjuvant therapy. Outcomes: Six weeks later, the tumor dramatically shrunk from 56 x 37 mm to 29 x 26 mm with well-controlled mild hypertension. After a 10-day interval of apatinib withdrawal, complete tumor excision was accomplished through cervical incision without esophageal fistula. Postoperative thyroid stimulating hormone suppression and radioiodine I-131 ablation therapy were performed. At the 1-year follow-up evaluation, no tumor recurrence or metastasis was observed. Lessons: Preoperative short term targeted treatment with apatinib for locally advanced inoperable DTC may become a promising neoadjuvant therapy that, can reduce the tumor size and decrease stage, thus making the complete and safe removal of the lesion feasible.