Multimodality treatment for anaplastic thyroid carcinoma – Treatment outcome in 75 patients

• Published in: Radiotherapy and oncology Vol. 92; no. 1; pp. 100 - 104
• Main Authors: Swaak-Kragten, Annemarie T, de Wilt, Johannes H.W, Schmitz, Paul I.M, Bontenbal, Marijke, Levendag, Peter C
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.07.2009
• Subjects: Aged; Anaplastic thyroid carcinoma; Carcinoma - pathology; Carcinoma - therapy; Combined Modality Therapy; Female; Hematology, Oncology and Palliative Medicine; Humans; Hyperfractionated radiotherapy; Local control; Male; Multimodality therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Prophylactic lung irradiation; Retrospective Studies; Risk Factors; Survival; Thyroid Neoplasms - pathology; Thyroid Neoplasms - therapy; Treatment Outcome; Multimodality therapy; Hyperfractionated radiotherapy; Local control; Survival; Prophylactic lung irradiation; Anaplastic thyroid carcinoma
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2009.02.016

Abstract Purpose To retrospectively analyze the outcome of patients with anaplastic thyroid carcinoma (ATC) treated in the Erasmus MC. Material and methods Seventy-five ATC-patients were treated between 1972 and 2003. Mean age was 68 years. Tumor stage was IVA in 9%, IVB in 51%, and IVC in 40%. Thirty-six patients underwent up-front surgery, with 53% resulting in R0/R1 resection. Before 1988 adjuvant treatment consisted of conventional radiotherapy (RT) and/or chemotherapy (CT). As of 1988, 30 eligible patients were enrolled in a newly designed protocol. This consists of locoregional RT in 46 fractions of 1.1 Gy, given twice daily, followed by prophylactic irradiation of the lungs (PLI) in 5 daily fractions of 1.5 Gy. During radiation, low-dose Doxorubicine (15 mg/m2 ) is administered weekly and is followed by adjuvant Doxorubicine (50 mg/m2 ) 3-weekly up to a cumulative dose of 550 mg/m2 . Twenty-five ineligible patients were treated conventionally. Results Overall median survival was 3 months, 1-year OS 9%. Locoregional control was significantly higher in patients who had undergone R0/R1 resection or chemoradiation, with best results for patients who underwent both (complete remission in 89%). However, the survival benefit of patients who reached CR remained borderline (median OS 7 months, 1-year OS 32%). Three patients survived for more than 5 years; all had undergone R0/R1 surgical resection and chemoradiation. Acute toxicity in the protocol group was significantly higher than in the nonprotocol group, with 46% versus 11% grade 3 pharyngeal and/or esophageal toxicity. Conclusion Despite the ultimately dismal prognosis of ATC-patients, multimodality treatment significantly improved local control and improved the median survival.