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Anaplastic thyroid carcinoma: changing trends of treatment strategies and associated overall survival

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Abstract

Purpose

The prognosis of anaplastic thyroid cancer (ATC) is poor. Despite various attempts to modify common treatment modalities, including surgery, external beam radiation (EBRT) and chemotherapy (CTX), no standardized treatment is yet established. This study aimed to analyze the changing trends of treatment concepts and associated overall survival (OS) over the last two decades.

Methods

A retrospective analysis was conducted on 42 patients with histologically confirmed ATC. The outcome measures included the evaluation of clinical characteristics and treatments performed with regard to OS.

Results

Median OS for all tumor stages was 6 (range 1 week–79) months, 6.5 months for stage IVA/B and 4 months for stage IVC carcinoma patients. Twenty-one patients with stage IVA/B carcinomas underwent curative treatment, including thyroidectomy with lymphadenectomy (TTX plus LAD, n = 11) or multimodal treatment with TTX plus LAD and EBRT plus/minus CTX (n = 10). The median OS of patients with stage IVA/B carcinomas was significantly prolonged after multimodal treatment than after surgery alone (25 vs. 3 months, p = 0.04). Fifteen of 18 patients with stage IVC carcinomas received palliative, 3 patients multimodal treatment. The median OS of stage IVC patients after trimodal therapy was not significantly longer than after debulking procedures (6 vs. 7 months, p = 0.25). In the time period 1999–2009, only 4 (21%) patients received multimodal treatment compared to 9 (39%) in the period from 2009 to 2019, but this did not result in a significantly prolonged survival in the latter period (8.5 vs. 15 months, p = 0.61).

Conclusion

Concurrent radio- and/or chemotherapy in combination with surgery seems to result in improved survival in stage IVA/B ATC, whereas this is not the case in patients with stage IVC tumors. Novel treatment regimens are urgently needed to improve the dismal prognosis of ATC.

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Funding

No funding was received.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany

    Sabine Wächter, I. Mintziras, I. Fülber, J. Manoharan, D. K. Bartsch & E. Maurer

  2. Department of Surgery, Bürgerhospital Frankfurt Am Main, Nibelungenallee 37-41, 60318, Frankfurt am Main, Hessen, Germany

    C. Vorländer

  3. Department of Surgery, Asklepios Klinik Lich, Goethestrasse 5, 35423, Lich, Hessen, Germany

    J. Schabram

  4. Section of Endocrine Surgery, Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany

    K. Holzer

Authors
  1. Sabine Wächter
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  2. C. Vorländer
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  3. J. Schabram
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  4. I. Mintziras
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  5. I. Fülber
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  6. J. Manoharan
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  7. K. Holzer
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  8. D. K. Bartsch
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  9. E. Maurer
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Corresponding author

Correspondence to Sabine Wächter.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the institutional ethics committee of the University Hospital of Marburg (reference number: ek_mr_110118_waechter).

Informed consent

Informed consent was obtained from all individual participants included in this study, who are still alive. Due to the retrospective nature of this study and the fact that except of two patients all patients were dead at the evaluation point in august 2019, no informed consent was obtained from the other 40 patients. Furthermore this study does not contain any identifying information about participants.

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Wächter, S., Vorländer, C., Schabram, J. et al. Anaplastic thyroid carcinoma: changing trends of treatment strategies and associated overall survival. Eur Arch Otorhinolaryngol 277, 1507–1514 (2020). https://doi.org/10.1007/s00405-020-05853-8

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  • DOI: https://doi.org/10.1007/s00405-020-05853-8

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