Enhanced Survival in Locoregionally Confined Anaplastic Thyroid Carcinoma: A Single-Institution Experience Using Aggressive Multimodal Therapy

Abstract

Background: Historical outcomes in anaplastic thyroid carcinoma (ATC) are poor, with a median survival of only 5 months and <20% of patients surviving 1 year from diagnosis. We hypothesized that survival in newly diagnosed patients with stages IVA and IVB locoregionally confined ATC might be improved by utilizing an aggressive therapeutic approach, prioritizing both the eradication of disease in the neck and preemptive treatment of occult metastatic disease. Methods: Between January 1, 2003, and December 31, 2007, 25 new ATC patients were evaluated at our institution. Of these 25 patients, 10 (40%) had metastatic disease at diagnosis and therefore underwent palliative treatment, whereas 5 (20%) had regionally confined disease and desired treatment at their local medical facilities. The remaining 10 consecutive patients (40%) had regionally confined ATC and elected aggressive therapy combining individualized surgery (where feasible), intensity-modulated radiation therapy (IMRT), and radiosensitizing + adjuvant chemotherapy intending four cycles of docetaxel + doxorubicin. Outcomes were assessed on an intention to treat basis. Results: There were no deaths from therapy, but hospitalization was required in two patients (20%) because of treatment-related adverse events. Five patients (50%) are alive and cancer-free, all having been followed >32 months (range: 32-89 months; median: 44 months) with a median overall Kaplan-Meier survival of 60 months. Overall survival at 1 and 2 years was 70% and 60%, respectively, compared to <20% historical survival at 1 year in analogous patients previously treated with surgery and conventional postoperative radiation at our and other institutions. Conclusions: Although based upon a small series of consecutively treated patients, an aggressive approach combining IMRT and radiosensitizing plus adjuvant chemotherapy appears to improve outcomes, including survival in stages IVA and IVB regionally confined ATC, but remains of uncertain benefit in patients with stage IVC (metastatic) disease. Also uncertain is the optimal chemotherapy regimen to use in conjunction with IMRT. Further multicenter randomized trials are required to define optimal therapy in this rare but deadly cancer.

A rare breast tumors: Primary neuroendocrin carcinoma

“…Mostly doxorubicin-based regimens were used, and the median survival ranged from 6 months to 1 year (16,17). Also, chemotherapy with a combination of taxane, anthracyclines, and cysplatin was proposed to have considerable palliative effects (18). Although combination chemotherapy was shown to improve the effects of radiation treatment in locoregional and distant disease control in a retrospective series (19), randomized controlled trials are not available to demonstrate the benefits of combined chemotherapy.…”

Treatment Outcome and Prognostic Factors of Anaplastic Thyroid Carcinoma: A Single Institution Experience in Egypt

“…Early events are mutations of the BRAF and RAS oncogenes in 25% and 28% respectively. Late genetic events include TP53 which is the most common mutation in ATC, PIK3CA and PTEN gene mutations are commonly found in differentiated thyroid cancers indicating that such mutations may be early steps in cancer formation 5,10,11 .…”

“…Types of surgery include total thyroidectomy with or without neck dissection, subtotal thyroidectomy, hemithyroidectomy, and debulking 14,15 . Surgery is followed by adjuvant radiotherapy (RT) and/or chemotherapy for favorable results 4,11,14 . The local tumor extent and the general condition of the patient determine the surgical strategy.…”

Preclinical efficacy of the oncolytic measles virus expressing the sodium iodide symporter in iodine non-avid anaplastic thyroid cancer: a novel therapeutic agent allowing noninvasive imaging and radioiodine therapy

“…2 ATC are poorly differentiated tumors that exhibit resistance to most treatment modalities, consequently, the 1-year survival rate after diagnosis is only 5--15%. 3,4 As single modality therapy has been shown to have a limited effect on ATC, multimodality therapy has become the treatment of choice in recent years, 5 with the hope of leading to at least reduced tumor mass and palliative control of the cancer.…”