Multimodality therapeutic approach in anaplastic thyroid cancer (ATC): Study of 56 patients

Abstract

5571 Background: To investigate the role of multimodality treatment in patients with ATC. Methods: From 1992 to 2005, 56 patients with a histologically or cytologically proven ATC were referred to the Thyroid Centre of Padua University General Hospital. There were 36 females and 20 males, median age 69 years (range 27–90). About one-third of patients had a history of prior nodular goitre. Aggressive local disease was present in 30 patients, distant metastases, mainly to the lung, were present in 32 at diagnosis or quickly developed during the observation period in all but one patient. Patients from our series can be subdivided into 3 groups: Group A: consisted of 19 patients in good general condition which were treated by radiotherapy (RT), total thyroidectomy (TT) and chemotherapy (CHT). All were treated with Cisplatin once a week and by RT 36 Gy in 18 fractions over 3 weeks, followed by TT and by further CHT with Adriamycin and Bleomycin. Additionally, five patients received weekly Docetaxel. Group B: consisted of 19 patients with distant metastasis at diagnosis, who received CHT (Platinum based combination). Group C: consisted of 18 elderly patients in poor general condition; 6 received local RT, while 12 did not receive any treatment. Results: Five complete responses were seen in patients from group A. Four patients had long-term survival (14, 15, 24 and 41 months) with a disease free survival interval of 6, 8, 11 and 32 months. From Group B one patient with a complete remission following antiblastic therapy was later treated by TT and metastasectomia and is still alive without disease after 74 months. Median survival rates for Groups A, B and C were 12, 5.7 and 4 months respectively. Conclusions: In some patients multimodality treatment is associated with increased survival. The best results were obtained in younger patients with less advanced disease. Early diagnosis is mandatory. Only a few patients responded to CHT confirming that anaplastic thyroid carcinoma is often resistant to anticancer drugs. Our experience with combination modalities suggests that aggressive and appropriate combinations of RT, TT and CHT may provide some benefit in patients with ATC. Preoperative RT and CHT may enhance surgical resectability of the primary tumor. No significant financial relationships to disclose.

Anaplastic Thyroid Cancer: A Review of Epidemiology, Pathogenesis, and Treatment

“…Chemotherapies with bleomycin, etoposide, cisplatin, and methotrexate have poor response rates with no long-term survival [ 9 , 65 ]. Other combinations with vincristine and melphalan have not produced any improvements in the rate of responders [ 75 , 82 ].…”

Anaplastic Thyroid Cancer: Experience of the Philippine General Hospital

“…Doxorubicin is the most commonly used agent [ 7 ]. Bleomycin, etoposide, cisplatin, and methotrexate have poor response rates and no long-term survival benefit for ATC [ 20 ]. Although chemotherapy appears unpromising, based on international studies, it might still confer some therapeutic benefit if used in combination with other modalities and should therefore be considered for ATC patients.…”