Anaplastic thyroid carcinoma: clinical outcome of 30 consecutive patients referred to a single institution in the past 5 years

Abstract

Objective: Treatment options for anaplastic thyroid carcinoma (ATC), which is one of the most lethal human malignant tumors, include surgery, chemotherapy and radiotherapy usually combined in a multimodal approach, to improve survival and avoid death from local invasion. However, there is no standard protocol for ATC treatment and the optimal sequence within multimodal therapy is debated. We retrospectively report the clinical outcome of 30 ATC patients referred consecutively to the Oncological Endocrinology Unit of San Giovanni Battista Hospital (Turin, Italy) between 2000 and 2005. Design: Patients were treated by one of the following approaches: i) surgery followed by adjuvantcombined chemoradiotherapy; ii) neo-adjuvant chemoradiotherapy followed by surgery and adjuvant chemotherapy; or iii) chemotherapy alone. The surgical procedures were classified as 'maximal debulking' or 'palliative resection'. Maximal debulking entailed total or near-total thyroidectomy and complete resection of all gross tumor or minimal residual disease adherent to vital structures, independently of the presence or absence of distant metastases. In palliative resections, macroscopic residual disease was left in the neck. Survival of patients stratified by treatment was assessed. Results: Analysis of multivariate hazard ratios showed that maximal debulking followed by adjuvant chemoradiotherapy was the only treatment that modified survival of ATC patients (hazard ratioZ 0.23, 95% CI: 0.07-0.79), even if factors determining poor prognosis or increased surgical risk were present. Conclusions: Despite the overall grim outcome of ATC, these results justify an attempt at maximal debulking surgery, followed by adjuvant chemoradiotherapy, possibly in all ATC patients. 156 425-430 European Journal of Endocrinology

Imatinib Enhances Docetaxel-Induced Apoptosis Through Inhibition of Nuclear Factor-κB Activation in Anaplastic Thyroid Carcinoma Cells

“…Multidisciplinary treatments, including radio-and chemotherapies, still poorly control the progression of this disease, and its mean survival is less than one year after initial diagnosis (1). Therefore, there is a critical need to develop a novel approach to treat patients with ATC.…”

Minimally invasive thyroid anaplastic carcinoma with long survival

“…Also, chemotherapy with a combination of taxane, anthracyclines, and cysplatin was proposed to have considerable palliative effects (18). Although combination chemotherapy was shown to improve the effects of radiation treatment in locoregional and distant disease control in a retrospective series (19), randomized controlled trials are not available to demonstrate the benefits of combined chemotherapy. Thus, there is no standard regimen for classic-type ATC in an adjuvant setting.…”

A Case of Toxic Multinodular Goiter with Anaplastic Carcinoma

“…All of these, especially if used alone, most often fail to control local disease. 11 The diagnosis of ATC is usually suspected on clinical examination, though fine needle aspiration can be an effective diagnostic modality, surgical biopsy as it has been shown to be accurate in 90% of patients. The initial fine needle aspiration biopsy showed colloid goiter, but sampling error due to increased areas of necrosis, hemorrhage, or fibrosis have been known to occur.…”