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

Yejee Lim; Yeon Sil Kim; Chan Kwon Jung; Dong Jun Lim

doi:10.11106/ijt.2015.8.2.198

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Lim, Kim, Jung, and Lim: A Case of Adjuvant Treatment with Sorafenib after Radiotherapy for Brain Metastasis from Poorly Differentiated Thyroid Carcinoma

Case Report

Int J Thyroidol 2015;8(2):198-203.

Published online: 20 November 2015

DOI: https://doi.org/10.11106/ijt.2015.8.2.198

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

Yejee Lim¹, Yeon Sil Kim², Chan Kwon Jung³, Dong Jun Lim^1,

¹Division of Endocrinology and Metabolism, Department of Internal Medicine¹

²Division of Endocrinology and Metabolism, Department of Radiation Oncology, The Catholic University of Korea, College of Medicine, Seoul, Korea

³Division of Endocrinology and Metabolism, Department of Hospital Pathology, The Catholic University of Korea, College of Medicine, Seoul, Korea

Correspondence: Dong Jun Lim, MD, Seoul St. Maryʼ s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-6009, Fax: 82-2-599–3589, E-mail: ldj6026@catholic.ac.kr

Received 16 February 2015 Revised 18 March 2015 Accepted 27 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Thyroid carcinoma, Brain, Sorafenib

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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).

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