Anaplastic Thyroid Cancer: Clinical Picture of the Last Two Decades at a Single Oncology Referral Centre and Novel Therapeutic Options

Abstract

Anaplastic thyroid cancer (ATC) is a rare tumour but also one of the most lethal malignancies. Therapeutic modalities have usually been limited, but clinical trials with new drugs are now being implemented. The aims of this study were to analyse the clinical presentation, therapeutic modalities and independent prognostic factors for survival. We also reviewed the most recent literature on novel ATC therapies. We performed a retrospective analysis of 79 patients diagnosed between 2000 and 2018. Variables with impact on survival were identified using the Cox proportional-hazard regression model. At presentation, 6.3% had thyroid-confined disease, 30.4% evidenced extrathyroidal extension and 60.8% were already metastatic. Surgery was feasible in 41.8% and radiotherapy was applied to 35.4%, with those receiving >45 Gy having longer estimated survival (p = 0.020). Chemotherapy, either conventional or with tyrosine kinase inhibitors, was performed in 17.7% and 7.6%, respectively. Multimodality therapy with surgery, radiotherapy and chemotherapy/tyrosine kinase inhibitors (TKI) had the greatest impact on disease specific survival (DSS), providing a risk reduction of death of 96.9% (hazard ratio (HR) = 0.031, 0.005–0.210, p < 0.001). We concluded that most of these patients join reference centres at advanced stages of disease and multimodality treatment may offer the best chances for prolonging survival.

Clinical Outcome and Toxicity in the Treatment of Anaplastic Thyroid Cancer in Elderly Patients

“…Importantly, more than 40% of all ATC cases occur in advanced stages, which means that symptoms of local compression with dyspnea and dysphagia and/or distant metastases are present [ 1 , 5 , 8 , 13 , 14 , 66 ]. These cases correspond to the unresectable stage IVB or stage IVC, in which, usually, no surgery or only an incomplete resection (R2) is possible [ 2 , 5 , 7 ].…”

“…These cases correspond to the unresectable stage IVB or stage IVC, in which, usually, no surgery or only an incomplete resection (R2) is possible [ 2 , 5 , 7 ]. In this situation, definitive chemoradiotherapy may provide local control and symptomatic relief [ 6 , 7 , 8 , 50 ].…”

“…Its aggressive growth leads to the rapid infiltration of vital adjacent organs, such as the trachea, larynx and esophagus, as well as neck vessels, nerves and muscles. Additionally, early metastases commonly to lung and bones [ 6 , 7 , 8 , 9 ] result in fatal outcomes with a median overall survival (OS) that ranges between three and six months [ 10 ]. The overall one-year survival rate is only 10–20% [ 1 , 4 , 5 , 11 , 12 , 13 , 14 ].…”

Cetuximab-Conjugated Perfluorohexane/Gold Nanoparticles for Low Intensity Focused Ultrasound Diagnosis Ablation of Thyroid Cancer Treatment

“…Several reports have shown that overexpression of the epidermalgrowth factor receptor (EGFR) is strongly associated with tumorprogression, migration, and invasion. EGFR is common in ATCpatients [18].…”

What Is New in Thyroid Cancer: The Special Issue of the Journal Cancers

“…Simões-Pereira et al analyzed the clinical presentation, therapeutic modalities and outcomes, as well as the prognostic factors influencing disease specific survival (DSS), in a homogenous population of ATC followed at a single institution. They showed that most of the patients join reference centers at advanced stages of disease and multimodality treatment may offer the best chances for prolonging survival [ 25 ]. Ravi et al performed whole exome sequencing and the RNA-sequencing of fourteen cases of ATC to delineate copy number changes, fusion gene events, and somatic mutations.…”