Anaplastic thyroid carcinoma
Multimodality treatment for anaplastic thyroid carcinoma – Treatment outcome in 75 patients

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Abstract

Purpose

To retrospectively analyze the outcome of patients with anaplastic thyroid carcinoma (ATC) treated in the Erasmus MC.

Material and methods

Seventy-five ATC-patients were treated between 1972 and 2003. Mean age was 68 years. Tumor stage was IVA in 9%, IVB in 51%, and IVC in 40%. Thirty-six patients underwent up-front surgery, with 53% resulting in R0/R1 resection. Before 1988 adjuvant treatment consisted of conventional radiotherapy (RT) and/or chemotherapy (CT). As of 1988, 30 eligible patients were enrolled in a newly designed protocol. This consists of locoregional RT in 46 fractions of 1.1 Gy, given twice daily, followed by prophylactic irradiation of the lungs (PLI) in 5 daily fractions of 1.5 Gy. During radiation, low-dose Doxorubicine (15 mg/m2) is administered weekly and is followed by adjuvant Doxorubicine (50 mg/m2) 3-weekly up to a cumulative dose of 550 mg/m2. Twenty-five ineligible patients were treated conventionally.

Results

Overall median survival was 3 months, 1-year OS 9%. Locoregional control was significantly higher in patients who had undergone R0/R1 resection or chemoradiation, with best results for patients who underwent both (complete remission in 89%). However, the survival benefit of patients who reached CR remained borderline (median OS 7 months, 1-year OS 32%). Three patients survived for more than 5 years; all had undergone R0/R1 surgical resection and chemoradiation. Acute toxicity in the protocol group was significantly higher than in the nonprotocol group, with 46% versus 11% grade 3 pharyngeal and/or esophageal toxicity.

Conclusion

Despite the ultimately dismal prognosis of ATC-patients, multimodality treatment significantly improved local control and improved the median survival.

Section snippets

Materials and methods

We retrospectively reviewed the charts of all patients treated for ATC between 1971 and 2003 at the Erasmus Medical Center/Daniel den Hoed Cancer Center. Diagnosis was established by fine needle aspiration, biopsy or by the pathological examination of the surgical specimen. Pathology slides of patients surviving more than 6 months were retrospectively reviewed by one of our staff pathologists. All patients were followed until death or time of analysis.

Treatment groups

Patients can be divided into three different treatment groups as described above:

  • •

    Group 1: patients treated before 1988 (n = 20; non-protocol).

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    Group 2: patients treated per protocol as of 1988 (n = 30).

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    Group 3: those patients treated after 1988 but outside the ATC protocol (n = 25; non-protocol).

Some patient characteristics of the three treatment groups are summarized in Table 1.

Of the 30 protocol patients, 17 presented without distant metastasis (M0). Table 2 illustrates the outcome of these patients.

Discussion

The present retrospective study of 75 patients concerns a population with characteristics similar to those described in the literature: in short, ATC typically concerns older patients of whom a large percentage already has distant metastases at presentation. The overall survival is dismal, irrespective of treatment, with a median survival of only 2.9 months in this series. This is also in correspondence with previously published studies [2], [4], [6], [13], [16].

A total of 30 patients were

Conclusion

Patients with anaplastic thyroid carcinoma have a dismal prognosis with a median survival of only 3 months in the present study. Aggressive multimodality treatment significantly improved local control, with a long time survival rate of 10%, at the expense of considerable acute morbidity. Prophylactic lung irradiation could be a promising treatment modality but needs further study with larger numbers.

Acknowledgments

We greatly appreciate the work of the clinicians of the Erasmus MC/Daniel den Hoed Cancer Center in their strive for excellence in patient care. Authors have no actual or potential conflicts of interest regarding the data presented in current research.

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