Concurrent palliative external radiotherapy with sorafenib or doxorubicin for bulky differentiated thyroid carcinoma: A case report

Administration of external beam radiotherapy (EBRT) for a bulky recurrence or primary bulky tumor of differentiated thyroid carcinoma (DTC) is rare. No previous experience is available on the feasibility of administering EBRT simultaneously with systemic treatment with doxorubicin or sorafenib, or both. The present case study reported the results from two different institutions on 5 consecutive patients. Side effects and tolerance to radiotherapy plus systemic treatment with doxorubicin (20 mg/m2 intravenously weekly for 6/8 consecutive weeks) or sorafenib (400 mg/12 h orally for 8 weeks) or both, were analyzed in patients with DTC. The local response to radiotherapy and patient outcome was also analyzed. A total of 4 males and 1 female, aged 37–62 years with cervical bulky mass DTC were included. The pathological tumor types were papillary (2 patients), follicular (2 patients) and medullar thyroid carcinoma (1 patient). The radiated cervical mass was local recurrence in 3 cases and primary tumor in the other two. The total dose of radiotherapy ranged between 50 and 64.8 Gy. Three patients received sorafenib, 1 patient received doxorubicin and 1 patient received both treatments. The total planned dose of radiotherapy was administered to all patients. Grade 2 anemia and erythrodysesthesia was the most frequent toxicity. Only the patient who received doxorubicin plus sorafenib had grade 3 toxicity consisting of lymphopenia, folliculitis and mucositis. All but 1 patient had a good local response to radiotherapy. The administration of EBRT concurrently with sorafenib and doxorubicin to patients with DTC with a bulky cervical mass is feasible.