Optimal combination of treatment modality to increase survival in patients with anaplastic thyroid carcinoma

Abstract

There is little consensus on the optimal treatment approach for newly diagnosed patients. The present study aims to provide additional evidence by evaluating a series of patients diagnosed with anaplastic thyroid carcinoma (ATC) and analyzing factors related to increased survival. This was a retrospective cohort report structured according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guideline. Demographics, chief complaint, history of prior thyroid cancer, stage at presentation, management modalities (surgery, chemotherapy, radiotherapy, or observation), completeness or resection, and survival period since initial diagnosis were reviewed for patients with documentation of histologic ATC diagnosis between 2003 and 2016. The median survival period for 34 patients (11 males, 23 females) was 93.5 days. Patients aged 70 or younger (111 days) tended to survive longer than those older 70 (88 days) (P = .081). Observation, surgery only, radiotherapy only, and chemo-radiotherapy after surgery group showed median survival of 88 days, 49 days (range 14–528), 61.5 days, and 225 days, respectively. There was also no significant difference in survival between the 10 (29.4%) stage IVb (225 days) and 23 (67.7%) IVc (88 days) patients (P = .242). The median survival of the R1 resection group was 514 days while that of the R2 group was 102 days (P = .338). There were no significant difference between patients with the de novo ATC (112 days) and patients with papillary thyroid carcinoma origin ATC (99 days) (P = .297). Results from our series of 34 patients with ATC show that more intense combination of surgery and chemo-radiotherapy tends to secure a longer survival period. Therefore we recommend a multi-modality approach after a comprehensive consultation with the patient.

Anaplastic Thyroid Cancer: Recent Trend Toward Improved Survival

“…With the gradual deepening research of ATC, optimal combination of treatment modality has played an increasingly important role. Joon-Hyop Lee analyzed thirty-four ATC patients and found that a more intense combination of surgery and chemo-radiotherapy tends to secure a longer survival period [13]. Additionally, there is another limitation in our study.…”

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 ].…”

“…Recent studies show that trimodal treatment (surgery, radiotherapy and chemotherapy) combined as a multimodal therapy significantly improves both OS and PFS in patients with ATC [ 3 , 5 , 11 , 13 , 14 , 15 , 16 ]. As a result, this multimodal therapy regime is increasingly becoming the standard of care, especially for patients in stage IVA and resectable stage IVB [ 1 , 12 , 14 ] and was incorporated into national and international guideline recommendations [ 1 , 69 ].…”

“…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 ].…”

“…Due to its low incidence, large prospective trials are rarely performed. However, several studies propose a multimodal therapy regime, consisting of radical resection, radiotherapy and chemotherapy, to improve outcomes in ATC patients [ 3 , 11 , 13 , 14 , 15 ]. Despite this, survival has remained relatively stable over the past decades [ 2 ], especially in elderly patients, who make up an important subgroup of ATC patients, among which prognosis is very poor [ 3 , 4 , 12 , 15 , 16 , 17 , 18 ].…”