Adjuvant external beam radiotherapy for surgically resected, nonmetastatic anaplastic thyroid cancer

Abstract

Background: EBRT in resected, nonmetastatic anaplastic thyroid cancer (ATC) remains undefined. We evaluated patterns/outcomes with EBRT and chemotherapy in this setting. Methods: This retrospective analysis included patients identified from the National Cancer Database with nonmetastatic ATC from 2004 to 2014 who underwent non-palliative resection.Results: Our analysis included 496 patients, including 375 who underwent adjuvant EBRT (among whom 198 received concurrent chemotherapy). The median age was 68 years. On MVA, EBRT was associated with sex (OR 0.5, 95% CI 0.3-0.8, P = .002) and income (OR 2.2, 95% CI 1.4-3.3, P < .001). EBRT was associated with longer OS on UVA (12.3 vs 9.1 months, P = .004) and MVA (HR 0.7 [CI 0.6-0.9], P = .004). Concurrent chemoradiation was associated with longer OS on UVA (14.0 vs 9.1 months, P = .003) and MVA (HR 0.6 [CI 0.5-0.8], P < .001).Conclusion: Adjuvant EBRT is associated with longer OS in resected, nonmetastatic ATC, with additional improved survival with concurrent chemotherapy.adjuvant chemotherapy, anaplastic thyroid carcinoma, combined modality therapy, head and neck cancer, radiation therapy

Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

“…99,160,[166][167][168][169][170] Adjuvant RT, especially when combined with concurrent chemotherapy, is associated with improved survival (see ANAP-A 1 of 3, page 942). 171 Higher RT dose is associated with OS in patients with unresected ATC. 172 For solitary brain lesions, either neurosurgical resection or RT is recommended.…”

Hypoxia in Solid Tumors: How Low Oxygenation Impacts the “Six Rs” of Radiotherapy

“…Anaplastic thyroid carcinomas (ATCs) account for 2-3% of thyroid gland neoplasms and are particularly aggressive tumors harboring a 3 to 4 months median survival ( 157 ). In this context, even though ATCs are often described as a radioresistant disease, adjuvant radiotherapy appears to increase the overall survival of patients with non-metastatic ATCs ( 158 ). Also, radiotherapy could offer a local control in advanced ATCs or for inoperable patients ( 159 ).…”

Comparative efficacy and safety of tyrosine kinase inhibitors for thyroid cancer: a systematic review and meta-analysis

“…These results demonstrate the feasibility of surgery after neoadjuvant dabrafenib and trametinib therapy for BRAF V600E mutation-positive ATC. In addition, adjuvant external beam radiotherapy following surgery reportedly prolongs the survival of patients with ATC [6,9,67,68]. Therefore, a multimodal treatment including neoadjuvant molecular targeted therapies, surgery, and external beam radiotherapy may be a potent therapeutic strategy for ATC.…”