Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

  • Anne-Birgitte Jacobsen
  • Krystyna K. Grøholt
  • Bianca Lorntzsen
  • Terje A. Osnes
  • Ragnhild Sørum Falk
  • Eva Sigstad
Head and Neck

Abstract

Anaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64 Gy) to the neck, followed by surgery 4–8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002–2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, with death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four were dependent on a tracheal cannula when they died. The best median survival, 19 months, was obtained in the 13 patients where both radiotherapy and surgery were possible as primary treatments. Only surgery came out as a prognostic factor for survival in multivariate analysis. Patients surviving more than 2 years were characterised by having surgery with R0 resection and no or small residual foci of ATC in the specimens. Stage 4C patients survived 3 months only.

Keywords

Anaplastic thyroid cancer Hyperfractionated accelerated radiotherapy Radiotherapy Thyroid surgery 

References

  1. 1.
    Bisof V, Rakusic Z, Despot M (2015) Treatment of patients with anaplastic thyroid cancer during the last 20 years: whether any progress has been made? Eur Arch Otorhinolaryngol 272:1553–1567CrossRefPubMedGoogle Scholar
  2. 2.
    Withers HR (1985) Biologic basis for altered fractionation schemes. Cancer 55:2086–2095CrossRefPubMedGoogle Scholar
  3. 3.
    Simpson WJ (1980) Anaplastic thyroid carcinoma: a new approach. Can J Surg 23:25–27PubMedGoogle Scholar
  4. 4.
    Tennvall J, Lundell G, Wahlberg P, Bergenfelz A, Grimelius L, Akerman M et al (2002) Anaplastic thyroid carcinoma: three protocols combining doxorubicin, hyperfractionated radiotherapy and surgery. Br J Cancer 86:1848–1853CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hoie J, Brennhovd IO, Host H, Stenwig AE (1986) Anaplastic thyroid carcinomas. Tidsskr Nor Laegeforen 106:2133–2136PubMedGoogle Scholar
  6. 6.
    DeLellis RA, Lloyd RV, Heitz PU et al (eds) (2004) World health Organization classification of tumours. Pathology and genetics of tumours of endocrine organs. IARC Press, LyonGoogle Scholar
  7. 7.
  8. 8.
    Wiseman SM, Loree TR, Rigual NR et al (2003) Anaplastic transformation of thyroid cancer: review of clinical, pathologic, and molecular evidence provides new insights into disease biology and future therapy. Head Neck 25:662–670CrossRefPubMedGoogle Scholar
  9. 9.
    Wallin G, Bäckdahl M, Tallroth-Ekman E, Lundell G, Auer G, Löwhagen T (1989) Co-existent anaplastic and well differentiated thyroid carcinomas: a nuclear DNA study. Eur J Surg Oncol 15:43–48PubMedGoogle Scholar
  10. 10.
    Wang Y, Tsang R, Asa S, Dickson B, Arenovich T, Brierley J (2006) Clinical outcome of anaplastic thyroid carcinoma treated with radiotherapy of once- and twice-daily fractionation regimens. Cancer 107:1786–1792CrossRefPubMedGoogle Scholar
  11. 11.
    Segerhammar I, Larsson C, Nilsson IL, Backdahl M, Hoog A, Wallin G et al (2012) Anaplastic carcinoma of the thyroid gland: treatment and outcome over 13 years at one institution. J Surg Oncol 106:981–986CrossRefPubMedGoogle Scholar
  12. 12.
    Glaser SM, Mandish SF, Gill BS, Balasubramani GK, Clump DA, Beriwal S (2016) Anaplastic thyroid cancer: prognostic factors, patterns of care, and overall survival. Head Neck 38:2083–2090CrossRefGoogle Scholar
  13. 13.
    Swaak-Kragten AT, de Wilt JH, Schmitz PI, Bontenbal M, Levendag PC (2009) Multimodality treatment for anaplastic thyroid carcinoma-treatment outcome in 75 patients. Radiother Oncol 92:100–104CrossRefPubMedGoogle Scholar
  14. 14.
    De Crevoisier R, Baudin E, Bachelot A, Leboulleux S, Travagli JP, Caillou B et al (2004) Combined treatment of anaplastic thyroid carcinoma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy. Int J Radiat Oncol Biol Phys 60:1137–1143CrossRefPubMedGoogle Scholar
  15. 15.
    Dandekar P, Harmer C, Barbachano Y, Rhys-Evans P, Harrington K, Nutting C et al (2009) Hyperfractionated accelerated radiotherapy (HART) for anaplastic thyroid carcinoma: toxicity and survival analysis. Int J Radiat Oncol Biol Phys 74:518–521CrossRefPubMedGoogle Scholar
  16. 16.
    Sherman EJ, Lim SH, Ho AL, Ghossein RA, Fury MG, Shaha AR et al (2011) Concurrent doxorubicin and radiotherapy for anaplastic thyroid cancer: a critical re-evaluation including uniform pathologic review. Radiother Oncol 101:425–430CrossRefPubMedGoogle Scholar
  17. 17.
    Nachalon Y, Stern-Shavit S, Bachar G et al (2015) Aggressive palliation and survival in anaplastic thyroid carcinoma. JAMA Otolaryngol Head Neck Surg 141:1128–1132CrossRefPubMedGoogle Scholar
  18. 18.
    Foote RL, Molina JR, Kasperbauer JL, Lloyd RV, McIver B, Morris JC et al (2011) Enhanced survival in locoregionally confined anaplastic thyroid carcinoma: a single-institution experience using aggressive multimodal therapy. Thyroid 21:25–30CrossRefPubMedGoogle Scholar
  19. 19.
    Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD et al (2012) American thyroid association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 22:1104–1139CrossRefPubMedGoogle Scholar
  20. 20.
    Susanne Singer Susan, Jordan Laura D, Locati et al (2017) The EORTC module for quality of life in patients with thyroid cancer: phase III. Endocr Relat Cancer 24:197–207CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Division of Cancer Medicine, Department of OncologyOslo University HospitalOsloNorway
  2. 2.Division of Laboratory Medicine, Department of PathologyOslo University HospitalOsloNorway
  3. 3.Division of Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck SurgeryOslo University HospitalOsloNorway
  4. 4.Oslo Centre for Biostatistics and EpidemiologyOslo University HospitalOsloNorway
  5. 5.Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloOsloNorway

Personalised recommendations