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

Abstract

Background: The present study aims to evaluate the outcomes and toxicity of elderly anaplastic thyroid cancer (ATC) patients receiving (chemo)radiotherapy, as well as to identify prognostic factors. Patients and methods: A systematic review using the MEDLINE/PubMed and Cochrane databases was performed. Individual data from all eligible studies were extracted, and a pooled analysis (n = 186) was conducted to examine patient characteristics and treatment. All consecutive ATC patients (≥65 years) treated between 2009 and 2019 at our institution were evaluated for outcomes concerning progression-free survival (PFS), overall survival (OS) probabilities and treatment-related toxicity. Results: The systematic review and pooled analysis identified age as a prognostic factor. The median OS of our patient cohort (n = 26) was three months (range = 0–125). The 6-, 12- and 24-month survival rates were 35%, 22% and 11%, respectively. In the univariate analysis, a Karnofsky performance status of >70%, the Union for International Cancer Control Tumor–Node–Metastasis classification, multimodal therapy and an EQD2 of >49 Gy were correlated with longer OS and PFS. The acute grade 3 toxicity of dysphagia, dyspnea, dermatitis, mucositis and dysphonia was found in 23%, 15%, 12%, 12% and 8% of patients. Conclusion: Age appears to be a prognostic factor in ATC. Elderly ATC patients can tolerate multimodal treatment and achieve a promising outcome. Prospective studies need to confirm our findings.

Radiation to the Primary Tumor in Metastatic Anaplastic Thyroid Cancer

“…Cancer Control tumor-node-metastasis (UICC TNM) stage (7)(8)(9). National and international guidelines recommend that ATC patients with stage IVA/B should be considered for radical surgery if negative pathological margins (R0/R1) can be achieved and should be avoided if there is a high chance of gross residual disease (R2) (2)(3)(4)(5).…”

“…Local radiotherapy (RT) should always be considered as part of the initial multimodal therapy approach to improve overall survival (OS) (6,(9)(10)(11) and provide local and symptom control in order to maintain quality of life. However, it is a matter of debate if local RT is still recommended in metastatic disease where aggressive systemic therapy has to be weighed against benefits from local control and limited systemic approaches.…”

Evolution of anaplastic thyroid cancer management: perspectives in the era of precision oncology

“… 7 Therefore, evaluation for securing the airway is an essential step in assessing patients with suspected or biopsy-proven ATC. 7 In addition, screening for distant disease, evaluation for feasibility of surgical resection followed by chemoradiation, and timely evaluation for BRAF mutation are critical steps in the managing these patients. The presence of distant metastases, tumor burden, and surgical eligibility have determined the subsequent phases of care.…”

“…The presence of distant metastases, tumor burden, and surgical eligibility have determined the subsequent phases of care. 7 , 8 In addition, the patient’s desires, comorbidities, and performance status play a role in determining treatment options. Involving palliative care early as collaborators in oncological care allows for additional assistance in symptoms management to maintain an optimal performance status within the clinical scenario.…”

“…3,6 Commonly, ATC presents as one or more rapidly growing neck lesions, involving thyroid, neck nodes, and in certain circumstances infiltrating soft tissues, nerve structures, esophagus, and trachea. 7 Therefore, evaluation for securing the airway is an essential step in assessing patients with suspected or biopsy-proven ATC. 7 In addition, screening for distant disease, evaluation for feasibility of surgical resection followed by chemoradiation, and timely evaluation for BRAF mutation are critical steps in the managing these patients.…”