Short Course High Dose Radiotherapy in the Treatment of Anaplastic Thyroid Carcinoma

Abstract

.Purpose. Anaplastic thyroid carcinoma (ATC) is a rare but aggressive tumor with limited survival. To date, the ideal radiation treatment schedule, one that balances limited survival with treatment efficacy, remains undefined. In this retrospective series we investigate the effectiveness and tolerability of hypofractionated radiation therapy in the treatment of ATC. Methods. 17 patients with biopsy proven ATC treated between 2004 and 2012 were reviewed for outcomes and toxicity. All patients received short course radiation. Results. The most commonly prescribed dose was 54 Gy in 18 fractions. Median survival was 9.3 months. 47% of patients were metastatic at diagnosis and the majority of patients (88%) went on to develop metastasis. Death from local progression was seen in 3 patients (18%), 41% experienced grade 3 toxicity, and there were no grade 4 toxicities. Conclusions. Here we demonstrated the safety and feasibility of hypofractionated radiotherapy in the treatment of ATC. This approach offers shorter treatment courses (3-4 weeks) compared to traditional fractionation schedules (6-7 weeks), comparable toxicity, local control, and the ability to transition to palliative care sooner. Local control was dependent on the degree of surgical debulking, even in the metastatic setting.

Hypofractionated Radiotherapy for Anaplastic Thyroid Carcinoma: 15 Years of Experience in a Single Institution

“…2). Stavas et al [9] reported results for patients who received ≥2.5 Gy/ fr (range 2.5-4 Gy), and the most frequently used radiotherapy dose was 54 Gy in 18 fractions (range 40-62.5 Gy). For those patients, the median OS was 9.3 months, which was better than the median OS in the present study.…”

“…Dandekar et al [8] reported that 31 patients received a protocol in which the total planned dose was 60.8 Gy in twicedaily fractions of 1.8 and 2 Gy and that local control (LC) was achieved in 27 patients, but the median OS was only 70 days. Stavas et al [9] used a dose of 54 Gy in 18 fractions, and LC was maintained in 14 of 17 patients. The median OS in their study was 9.3 months.…”

Radiation therapy dose is associated with improved survival for unresected anaplastic thyroid carcinoma: Outcomes from the National Cancer Data Base

“…To date, there still are no standard, highly effective treatment regimens for ATC, but treatment is generally multimodal. [6][7][8] Fit patients who present without sign of distant metastases are evaluated for surgery and adjuvant therapy to provide the best chance for a favorable outcome. However, because complete surgical resection is rarely feasible in ATC, radiation therapy (RT), often with concurrent chemotherapy, is considered in an attempt to induce local tumor regression (and achieve interim local control) and to avoid or delay local progression, preventing or deferring airway obstruction, severe dysphagia, and/or death secondary to overwhelming local tumor burden: scenarios that unfortunately are common in these patients despite prompt tracheostomy.…”

Radiotherapy in anaplastic thyroid carcinoma: An Australian experience

“…She survived 18.5 months and died of metastatic disease having maintained loco‐regional control until the time of death. Stavas et al . also found high rates of loco‐regional control when they retrospectively reviewed 17 patients who had received dose fractionation schedules of 2.5 Gy per fraction or higher.…”

“…loco-regional control until the time of death. Stavas et al 23 also found high rates of loco-regional control when they retrospectively reviewed 17 patients who had received dose fractionation schedules of 2.5 Gy per fraction or higher. In their study, the median survival was 9.3 months and approximately 80% maintained local disease control at the time of death.…”