Treatment of locally advanced thyroid carcinoma with combination doxorubicin and radiation therapy

Abstract

Since 1979, 41 patients with locally advanced thyroid cancers have been prospectively treated in our institution according to a combination regimen of low-dose Adriamycin (doxorubicin) and external-beam radiation therapy. Two types of treatment regimen were used depending on tumor histologic type. Group 1 patients with well-differentiated papillary, follicular, or mixed type tumor (n = 22) received the combined regimen consisting of once weekly administration of Adriamycin (10 mg/m2) before radiation therapy (RT). Radiation therapy was carried out with a daily dose of 200 cGy for 5 days per week to a total tumor dose of 5600 cGy. Group 2 patients with anaplastic giant and spindle cell carcinoma of the thyroid (n = 19) received the combined regimen, consisting of once weekly administration of Adriamycin (10 mg/m2) before hyperfractionated RT. Radiation therapy was carried out with a fractional dose of 160 cGy per treatment twice a day for 3 days per week to a total dose of 5760 cGy in 40 days. Initial complete tumor response rates in the group 1 and 2 were 91% and 84%, respectively. Local tumor control rates at 2 years after combined therapy were 77% and 68%, respectively. The median survival time was 4 years for group 1 and 1 year for group 2. There was no disproportionately enhanced normal tissue morbidity seen with this combined approach. Patients in group 1 have a good quality of life, once the local disease is under control due to the indolent course of the disease. On the contrary, most patients in group 2 promptly developed distant metastases and died from the disease.

Anaplastic thyroid carcinoma: three protocols combining doxorubicin, hyperfractionated radiotherapy and surgery

“…Following a report by Kim and Leeper (1983), we replaced the BCF with weekly administered doxorubicin. In addition to weekly doxorubicin, Kim and Leeper (1983;1987) used hyperfractionated but not accelerated radiotherapy, and reported results similar to those obtained in our protocol with BCF but with less toxicity. Our aim in this present study was to prospectively evaluate the treatment and change only one modality at a time; this practice will enable assessment of the various components in the multimodality treatment regimen.…”

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…There are no data to support the use of adjunctive chemotherapy in the management of differentiated thyroid cancer. Doxorubicin (adriamycin) may act as a radiation sensitizer in some tumors of thyroid origin (175,176), and could be considered for patients with locally advanced disease undergoing external beam radiation.…”

Anaplastic thyroid carcinoma

“…Toxicity can be a limiting factor with radiation. Kim and Leeper (1987) reported complications particularly, pharyngitis, esophagitis, and tracheitis in their series. Wong et al (1991) also noted skin changes, esophageal toxicity, and radiation myelopathy.…”