Anaplastic and Poorly Differentiated Thyroid Carcinoma: Therapeutic Strategies and Treatment Outcome of 52 Consecutive Patients

Abstract

Anaplastic thyroid carcinoma (ATC) is one of the most lethal malignancies; poorly differentiated thyroid carcinoma (PDTC) is a new diagnosis for rare aggressive thyroid tumours. Surgery is often considered the only chance for survival, but the benefit of surgery and subsequent multimodal therapy is unclear. We retrospectively analyzed the outcome of 44 ATC and 8 PDTC consecutive patients treated at Helsinki University Central Hospital between 1990 and 2008. All ATC and PDTC cases were re-examined and reclassified histologically. Median survival was only 3.1 months for ATC, but 3.7 years for PDTC. Most patients in both groups eventually died of cancer. ATC patients were older than PDTC patients (74 vs. 66 years). Nodal and distant metastases had a negative impact on survival (ATC; p = 0.038, p = 0.008). Long-term survivors in both groups were stage N0M0 at presentation. Multimodal therapy was successful for 9 (20%) ATC patients, and their median survival was the longest (11.6 months) among treatment groups. Most PDTC patients (88%) underwent total thyroidectomy followed by radioiodine ablation; the only 2 who received chemotherapy survived longest. Although ATC and PDTC are both aggressive thyroid carcinomas, multimodal therapy for both can provide a chance of prolonged survival in patients with locoregional disease.

Poorly Differentiated Thyroid Carcinoma Presenting with Gross Extrathyroidal Extension: 1986–2009 Memorial Sloan-Kettering Cancer Center Experience

“…The M1 rates in our cohort (37%) were similar to M1 rates reported by other investigators in PDTC where the majority of patients presented with gross ETE (T4) (18). However, the incidence of subsequent distant metastases was lower in our cohort, 22% vs. 50% (18). In contrast, our M1 rates were higher than those reported for DTC with ETE, 37% vs. 9% (19), as were the rates of subsequent distant metastases, 22% vs. 6% (12).…”

“…Only three patients died as a result of airway involvement from locoregional recurrence. The M1 rates in our cohort (37%) were similar to M1 rates reported by other investigators in PDTC where the majority of patients presented with gross ETE (T4) (18). However, the incidence of subsequent distant metastases was lower in our cohort, 22% vs. 50% (18).…”

“…Of 14 patients (52%) who died, 11 patients died of distant disease alone, and three died of locoregional disease with distant disease also being present. In recent reports on PDTC, almost all deaths from PDTC (with 63% of patients having ETE) were caused by distant disease (50% due to distant disease, and 50% due to both local and distant disease) (18). In concordance with these results, distant disease was the only significant predictor for survival on multivariate analysis in PDTC (24).…”

Malignant Pleural Effusion Resulting from Metastasis of Thyroid Primaries: A Cytomorphological Analysis

“…The most common sites of distant metastases include pulmonary parenchyma and bone, and these disease progressions are associated with a slightly higher mortality [17]. Less common sites of distant metastases such as the skin [18] and the central nervous system [19] appear to portend a poorer prognosis although in larger multivariate retrospective studies these sites appear to be associated with massive disseminated disease [20,21], so such metastatic developments may just be surrogates of greater tumor burden and harbingers of multiple organ failure. In contrast, involvement of the pleural space has been previously described only in conjunction with or following isolated pulmonary metastasis [4].…”

Obatoclax overcomes resistance to cell death in aggressive thyroid carcinomas by countering Bcl2a1 and Mcl1 overexpression

“…Although the vast majority of these tumors is effectively managed by surgical resection followed by radioactive iodine therapy (American Thyroid Association Guidelines Taskforce on Thyroid, et al 2009), a subset of lesions, which includes recurring well differentiated, poorly differentiated, and anaplastic tumors, is refractory to current therapeutic approaches, behaves aggressively, is almost invariably fatal, and thus represents a critical clinical issue (Ibrahimpasic, et al 2013; Siironen, et al 2010). …”