Successful surgical management of a patient with osteoradionecrosis of the jaw with RET fusion-positive advanced thyroid cancer: A case report.

Osteoradionecrosis (ORN) of the jaw is a severe complication of radiotherapy for head and neck cancer. Extensive surgical resection has shown promising outcomes; however, patients' prognosis must be considered. Papillary thyroid carcinoma (PTC) generally has a favorable prognosis, whereas metastatic PTC is considered a refractory disease against conventional treatment. Recently, comprehensive genomic profiling (CGP) has enabled clinicians to provide personalized medicine, offering patients with intractable disease further therapeutic options. The present case study reported on a patient with advanced PTC who developed ORN during lenvatinib treatment; extensive surgical treatment with submandibular dissection for ORN provided a favorable outcome. Pathological examination unexpectedly revealed PTC metastases in the dissected right submandibular gland. Postoperatively, the patient experienced worsening metastases to the lung and liver. CGP identified a CCDC6-RET fusion, prompting selpercatinib treatment, which achieved a partial response. This report aims to emphasize that extensive surgical treatment for ORN should be considered, even in patients with advanced cancer, if the patients' condition is stable. In addition, submandibular dissection is warranted in selected patients, particularly when thyroid cancer exhibits an aggressive phenotype with occult metastases. Furthermore, this report highlights the importance of integrating personalized medicine in the management of advanced cancer cases and emphasizes the availability of genomic profiling to guide treatment decisions.