Aggressive Palliation and Survival in Anaplastic Thyroid Carcinoma

JAMA Otolaryngol Head Neck Surg. 2015 Dec;141(12):1128-32. doi: 10.1001/jamaoto.2015.2332.

Abstract

Importance: Anaplastic thyroid carcinoma is an undifferentiated aggressive tumor with a high rate of regional and distant spread and a grave prognosis (median survival, 3 months) with no standardized treatment.

Objective: To review the effect of an active treatment policy on the outcome of anaplastic thyroid carcinoma.

Design, setting, and participants: Retrospective comparative study of all patients diagnosed as having anaplastic thyroid carcinoma and undergoing treatment from January 1, 2008, through December 31, 2013, in a tertiary university-affiliated medical center. Data were collected by medical record review. Final follow-up was completed on November 30, 2014. Data were analyzed from December 1 to 3, 2014.

Interventions: Treatment options included surgery and adjuvant concomitant radiotherapy and chemotherapy with doxorubicin hydrochloride or paclitaxel for local disease; full-dose chemoradiotherapy (70 Gy to the gross tumor) for local disease when surgery was not feasible; aggressive palliative radiotherapy (50 Gy to the gross tumor) for metastatic disease; and palliative radiotherapy (≤ 30 Gy) for metastatic disease with a low performance status.

Main outcomes and measures: Survival time and quality of life.

Results: Of the 26 patients (including 15 women) who met the inclusion criteria, 11 underwent radiotherapy with curative intent. These patients included 5 who underwent curative surgery (5 with chemotherapy) and 6 who received primary chemotherapy. Nine patients received aggressive palliative radiotherapy, and 3 received palliative radiotherapy. The remaining 3 patients were not treated. Curative radiotherapy was associated with a significantly longer overall median (95% CI) survival time (11 [8.1-13.9] months) than aggressive palliative radiotherapy (6 [3.1-8.9] months), palliative radiotherapy (3 [0.0-7.8] months), and no treatment (1 month) (P < .001). Chemotherapy in 10 patients had a significant effect on survival (mean [95% CI], 11 [1.2-6.8] vs 4 [8.1-13.9] months for patients who did not receive chemotherapy; P = .01). Among the patients who underwent surgery and curative radiotherapy, 3 were alive after more than 3 years of follow-up. No association of survival with patient sex (median [95% CI] survival for men and women, 9 [3.6-14.4] and 5 [0.3-9.7] months, respectively; P = .54) or a history of thyroid disease (median [95% CI] survival for those with and without, 4 [1.0-6.9] and 9 [5.4-12.5] months, respectively; P = .15) was found.

Conclusions and relevance: Anaplastic thyroid carcinoma has a grave prognosis, but an aggressive approach, including surgery, chemotherapy, and radiotherapy, seems to improve survival. Higher doses of radiotherapy may have a survival benefit in candidates for palliative treatment and may be considered for patients with extensive disease.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Palliative Care*
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Thyroid Carcinoma, Anaplastic / mortality
  • Thyroid Carcinoma, Anaplastic / pathology
  • Thyroid Carcinoma, Anaplastic / therapy*
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / therapy*
  • Treatment Outcome