Abstract
BackgroundAnaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC.Methods13 patients with ATC who were treated by IMRT in our institution between October 2008 and February 2011, have been analyzed. The target volume for IMRT was planned to include Gross tumor volume (GTV): primary tumor plus any N + disease (66 Gy/33 F/6.6 W), with elective irradiation of thyroid bed, bilateral level II through VI and mediastinal lymph nodes to the level of the carina (54-60 Gy). Seven patients received surgical intervention and eleven patients had chemotherapy.ResultsThe median radiotherapy dose to GTV was 60 Gy/30 fractions/6 weeks. The median survival time of the 13 patients was 9 months. The direct causes of death were distant metastases (75%) and progression of the locoregional disease (25%). Ten patients were spared dyspnea and tracheostomy because their primary neck lesion did not progress.ConclusionThe results showed that IMRT combined by surgery and chemotherapy for ATC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases.
Highlights
Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates
Because the prognosis for ATC is so poor, all ATC are classified as stage IV according to International Union Against Cancer (UICC) staging, regardless of tumor size, nodal status, and either absence or presence of distant metastasis
One patient at stage IVC developed enlargement of lung and head lesion during concurrent radiochemotherapy, the neck lesion shrunk after 50 Gy
Summary
Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC. Combined modality therapy with surgery, chemotherapy and two dimensional or conformal radiotherapy, have been adopted for ATC [6,7,8,9], but the results have not been satisfactory. Lim et al [8] reviewed the treatment outcome of 13 consecutive patients retrospectively, of which five, two, and six patients had stage IVA, IVB, and IVC disease respectively. They received 3-dimensional conformal radiotherapy and chemotherapy, plus surgery, the median progression-free survival and overall survival were 2.8 and 3.8 months respectively. The paper report the outcomes for the first 13 consecutive patients treated with IMRT combined with surgery and chemotherapy
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