Combination therapy for anaplastic giant cell thyroid carcinoma

Abstract

Since 1981, 20 patients with anaplastic giant cell carcinoma of the thyroid have been prospectively treated according to a combination regimen of chemotherapy and external beam radiation therapy. Two types of chemotherapy were used every 4 weeks, depending on the patient's age. For those younger than 65 years, a combination of doxorubicin (60 mg/m2) and cisplatin (90 mg/m2) was given, and for older patients mitoxantrone (14 mg/m2) was used. Radiotherapy was carried out between Day 10 and Day 20 of the first four cycles of chemotherapy. It delivered 17.5 Gy in 7 fractions to the neck and the superior mediastinum. Survival exceeding 20 months was observed in three patients. Complete neck tumor response was observed in five patients, among whom four had undergone previous operations. No response was seen in distant metastases, which were the cause of death in 14 patients. These treatment modalities are effective in some patients, both in terms of survival and of local control, avoiding death from local invasion. Gross tumor resection should be performed whenever possible but should not delay the commencement of this protocol. Toxicity was high and remains the main limiting factor.

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

“…No response was observed in distant metastases in the present study, nor in another study employing doxorubicin (60 mg m 2 ), cisplatin (90 mg m 2 ) and local radiation (Schlumberger et al, 1991). The use of a more aggressive cytostatic regimen in a multimodal approach is therefore not justified, except possibly in younger subjects in good performance upon termination of local therapy.…”

“…Surgery, radiotherapy, or chemotherapy used alone is seldom sufficient to control the disease (Aldinger et al, 1978;Venkatesh et al, 1990), while a combination of these modalities may improve local control (Venkatesh et al, 1990;Schlumberger et al, 1991). The rationale for combining radio-and chemotherapy is that, as the toxicity of these modalities does not entirely overlap, an enhanced tumouricidal effect may be obtained (Wendt et al, 1985).…”

“…As ATC is a rapidly growing tumour, it may be important to decrease the 'overall treatment time' by accelerating the fractionation of the radiotherapy regimen, thereby reducing the opportunity for tumour cells to repopulate during the course of treatment (Thames et al, 1982). Moreover, surgery can remove the large necrotic tumour mass, which theoretically may enhance the efficacy of the other treatment modalities (Schlumberger et al, 1991).…”

Anaplastic thyroid carcinoma

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] However, to our knowledge, few published data have shown any significant survival benefit from multimodal therapy.…”

Anaplastic Thyroid Carcinoma - a Therapeutic Dilemma

“…These results are in agreement with the reports which found no improvement in survival despite the combination of chemotherapy and radiotherapy, and which concluded that the role of chemotherapy, preoperatively or postoperatively is equivocal. 20,21 It has been acknowledged that the efficacy of radiotherapy for ATC is largely unsatisfactory, and in particular, conventional radiotherapy has not seemed to have any therapeutic effects at all. 19,22 Despite these disappointing results of conventional radiotherapy, hyperfractionated radiation therapy and combined chemotherapy has been suggested as a multimodal treatment approach to improve survival rates, 6,15,16 though some disagree.…”