Abstract
Background
Anaplastic thyroid carcinoma (ATC) is a notoriously aggressive malignancy associated with a highly lethal clinical course despite therapeutic intervention. Our present study attempts to identify factors that could potentially improve therapeutic strategies by analyzing the clinicopathological features, treatment and outcome of ATC patients managed over the past four decades at our institution.
Methods
Fifty patients with biopsy-proven ATC during the period 1966 to 2006 were studied. All patients were managed with surgery, radiotherapy, chemotherapy and/or chemoradiation. Survival was calculated by the Kaplan-Meier method. Potential factors affecting survival were compared by the log rank test.
Results
Most patients (88%) presented with a neck mass; 17 patients (34%) also had cervical lymphadenopathy. Distant metastases were clinically present in 9 (18%). Median survival was 97 days, whereas the 1- and 3-year survival was 14% and 8%, respectively. On univariate analysis, patients aged ≤65 years (P = .04), absence of metastatic disease at presentation (P < .01), surgical resection (P < .01), and postoperative radiotherapy (P < .01) were associated with longer survival. The adoption of cytotoxic chemotherapy was not associated with better survival (P = .4). Moreover, there was no improvement in survival rate over the last four decades despite the adoption of multimodal treatment (P = .5).
Conclusion
ATC remains a deadly disease despite technical advances in surgical technique and adoption of multidisciplinary treatment strategies over the last four decades. However, younger patients with localized ATC might benefit from an aggressive multidisciplinary approach.
Similar content being viewed by others
References
Hundahl SA, Fleming ID, Fremgen AM et al. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the US, 1985–1995. Cancer 1998;83:2638–48
Kitamura Y, Shimizu K, Nagahama M et al. Immediate causes of death in thyroid carcinoma: clinicopathological analysis of 161 fatal cases. J Clin Endocrinol Metab 1999;84:4043–9
Aldinger KA, Samaan NA, Ibanez M et al. Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Cancer 1978;41:2267–75
Demeter JG, De Jong SA, Lawrence AM et al. Anaplastic thyroid carcinoma: risk factors and outcome. Surgery 1991;110:956–61
Schlumberger M, Parmentier C, Delisle MJ et al. Combination therapy for anaplastic giant cell thyroid carcinoma. Cancer 1991;67:564–6
Kobayashi T, Asakawa H, Umeshita K et al. Treatment of 37 patients with anaplastic carcinoma of the thyroid. Head Neck 1996;18:36–41
Rosen IB. (1997) Anaplastic carcinoma of the thyroid gland. In Duh QY, Clark OH (eds). Textbook of Endocrine Surgery. Philadelphia: Sauders. 127–32
Goldman JM, Goren EN, Cohen MH et al. Anaplastic thyroid carcinoma: long-term survival after radical surgery. J Surg Oncol 1980;14:389–94
Mitchell G, Huddart R, Harmer C. Phase II evaluation of high dose accelerated radiotherapy for anaplastic thyroid carcinoma. Radiother Oncol 1999;50:33–8
Simpson WJ. Anaplastic thyroid carcinoma: a new approach. Can J Surg 1980;23:25–7
Kim JH, Leeper RD. Treatment of anaplastic giant and spindle cell carcinoma of the thyroid gland with combination Adriamycin and radiation therapy. A new approach. Cancer 1983;52:954–7
Tennvall J, Tallroth E, el Hassan A et al. Anaplastic thyroid carcinoma. Doxorubicin, hyperfractionated radiotherapy and surgery. Acta Oncol 1990;29:1025–8
Voutilainen PE, Multanen M, Haapiainen RK et al. Anaplastic thyroid carcinoma survival. World J Surg 1999;23:975–8
Kebebew E, Greenspan FS, Clark OH et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005;103:1330–5
Lo CY, Lam KY, Wan KY. Anaplastic carcinoma of the thyroid. Am J Surg 1999;177:337–9
Lang BH, Lo CY. Surgical options in undifferentiated thyroid carcinoma. World J Surg 2007;31:969–77
Myskow MW, Krajewski AS, Dewar AE et al. The role of immunoperoxidase techniques on paraffin embedded tissue in determining the histogenesis of undifferentiated thyroid neoplasms. Clin Endocrinol (Oxf) 1986;24:335–41
Tobler A, Maurer R, Hedinger CE. Undifferentiated thyroid tumors of diffuse small cell type. Histological and immunohistochemical evidence for their lymphomatous nature. Virchows Arch A Pathol Anat Histopathol 1984;404:117–26
Haigh PI, Ituarte PH, Wu HS et al. Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival. Cancer 2001;91:2335–42
Tan RK, Finley RK 3rd, Driscoll D et al. Anaplastic carcinoma of the thyroid: a 24-year experience. Head Neck 1995;17:41–7
Hadar T, Mor C, Shvero J et al. Anaplastic carcinoma of the thyroid. Eur J Surg Oncol 1993;19:511–6
Ain KB. Anaplastic thyroid carcinoma: behavior, biology, and therapeutic approaches. Thyroid 1998;8:715–26
Venkatesh YS, Ordonez NG, Schultz PN et al. Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases. Cancer 1990;66:321–30
Sugitani I, Kasai N, Fujimoto Y et al. Prognostic factors and therapeutic strategy for anaplastic carcinoma of the thyroid. World J Surg 2001;25:617–22
Sugino K, Ito K, Mimura T et al. The important role of operations in the management of anaplastic thyroid carcinoma. Surgery 2002;131:245–8
Pierie JP, Muzikansky A, Gaz RD et al. The effect of surgery and radiotherapy on outcome of anaplastic thyroid carcinoma. Ann Surg Oncol 2002;9:57–64
Shimaoka K, Schoenfeld DA, DeWys WD et al. A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 1985;56:2155–60
Asakawa H, Kobayashi T, Komoike Y et al. Chemosensitivity of anaplastic thyroid carcinoma and poorly differentiated thyroid carcinoma. Anticancer Res 1997;17:2757–62
Williams SD, Birch R, Einhorn LH. Phase II evaluation of doxorubicin plus cisplatin in advanced thyroid cancer: a Southeastern Cancer Study Group Trial. Cancer Treat Rep 1986;70:405–7
Ain KB, Egorin MJ, DeSimone PA. Treatment of anaplastic thyroid carcinoma with paclitaxel: phase 2 trial using ninety-six-hour infusion. Collaborative Anaplastic Thyroid Cancer Health Intervention Trials (CATCHIT) Group. Thyroid 2000;10:587–94
Schiff BA, McMurphy AB, Jasser SA et al. Epidermal growth factor receptor (EGFR) is overexpressed in anaplastic thyroid cancer, and the EGFR inhibitor gefitinib inhibits the growth of anaplastic thyroid cancer. Clin Cancer Res 2004;10:8594–602
Straight AM, Oakley K, Moores R et al. Aplidin reduces growth of anaplastic thyroid cancer xenografts and the expression of several angiogenic genes. Cancer Chemother Pharmacol 2006;57:7–14
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yau, T., Lo, C.Y., Epstein, R.J. et al. Treatment Outcomes in Anaplastic Thyroid Carcinoma: Survival Improvement in Young Patients With Localized Disease Treated by Combination of Surgery and Radiotherapy. Ann Surg Oncol 15, 2500–2505 (2008). https://doi.org/10.1245/s10434-008-0005-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-008-0005-0