The Role of Surgery in Multimodal Treatment of Anaplastic Thyroid Carcinoma

Abstract

Anaplastic thyroid carcinoma is a very aggressive tumour with poor prognosis and only occasional survivors beyond five years. Due to rapid growth of the tumour the majority of patients are technically inoperable when first seen by a surgeon. The aim of the present study was to assess whether the timing of surgery after chemotherapy and irradiation can prolong survival. Of 105 patients with anaplastic thyroid carcinoma treated from 1973–1991 at the Institute of Oncology Ljubljana, 32 had surgery as a part of multimodal treatment. In 22 patients (15 women, 7 men; age 40–77 years) surgery with curative intent was the first line of treatment followed by chemotherapy and/or irradiation. In 10 patients (6 women, 4 men; age 50–77 years) surgery was performed only after regression of tumour had been obtained by chemotherapy and/or irradiation. Surgery was total thyroidectomy in 16 patients, near-total thyroidectomy in nine patients, subtotal thyroidectomy in six patients and tumour resection in one patient. Irradiation was applied with a 60Co unit; a total dose of 45–64 Gy to the neck and mediastinum was delivered in 18 patients, 20–45 Gy in 12 patients and up to 20 Gy in two patients. Median survival of patients with surgery as the first treatment was five months whereas the median survival of patients treated by surgery after chemotherapy and/or irradiation was 19 months (p<0.03) in spite of larger, primarily inoperable tumours in the latter group. We conclude that timing of surgery after chemotherapy and irradiation may prolong survival. Chemotherapy and irradiation seem to be indicated before surgery in anaplastic thyroid carcinoma.