Abstract
Background: The present study aims to evaluate the outcomes and toxicity of elderly anaplastic thyroid cancer (ATC) patients receiving (chemo)radiotherapy, as well as to identify prognostic factors. Patients and methods: A systematic review using the MEDLINE/PubMed and Cochrane databases was performed. Individual data from all eligible studies were extracted, and a pooled analysis (n = 186) was conducted to examine patient characteristics and treatment. All consecutive ATC patients (≥65 years) treated between 2009 and 2019 at our institution were evaluated for outcomes concerning progression-free survival (PFS), overall survival (OS) probabilities and treatment-related toxicity. Results: The systematic review and pooled analysis identified age as a prognostic factor. The median OS of our patient cohort (n = 26) was three months (range = 0–125). The 6-, 12- and 24-month survival rates were 35%, 22% and 11%, respectively. In the univariate analysis, a Karnofsky performance status of >70%, the Union for International Cancer Control Tumor–Node–Metastasis classification, multimodal therapy and an EQD2 of >49 Gy were correlated with longer OS and PFS. The acute grade 3 toxicity of dysphagia, dyspnea, dermatitis, mucositis and dysphonia was found in 23%, 15%, 12%, 12% and 8% of patients. Conclusion: Age appears to be a prognostic factor in ATC. Elderly ATC patients can tolerate multimodal treatment and achieve a promising outcome. Prospective studies need to confirm our findings.
Highlights
Anaplastic thyroid cancer (ATC) is one of the rarest, yet one of the most lethal, carcinomas that is seen in the human body
Survival has remained relatively stable over the past decades [2], especially in elderly patients, who make up an important subgroup of anaplastic thyroid cancer (ATC) patients, among which prognosis is very poor [3,4,12,15,16,17,18]
A review of the literature was undertaken by two authors (T.A. and D.O.) in order to minimize the risk of selection bias
Summary
Anaplastic thyroid cancer (ATC) is one of the rarest, yet one of the most lethal, carcinomas that is seen in the human body. Survival has remained relatively stable over the past decades [2], especially in elderly patients, who make up an important subgroup of ATC patients, among which prognosis is very poor [3,4,12,15,16,17,18] This group of people often represents a combination of several comorbidities, immunodeficiencies and organ dysfunctions and may not tolerate aggressive treatment [19,20]. The present study aims to evaluate the outcomes and toxicity of elderly anaplastic thyroid cancer (ATC) patients receiving (chemo)radiotherapy, as well as to identify prognostic factors.
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