Abstract
Background Anaplastic thyroid cancer (ATC) is rare, accounting for 1-2% of thyroid malignancies. Median survival is only 3-10 months, and the optimal therapeutic approach has not been established. This study aimed to evaluate outcomes in ATC based on treatment modality. Methods Retrospective review was performed for patients treated at a single institution between 1990 and 2015. Demographic and clinical covariates were extracted from the medical record. Overall survival (OS) was modeled using Kaplan Meier curves for different treatment modalities. Univariate and multivariate analyses were conducted to assess the relationships between treatment and disease characteristics and OS. Results 28 patients with ATC were identified (n = 16 female, n = 12 male; n = 22 Caucasian, n = 6 African-American; median age 70.9). Majority presented as Stage IVB (71.4%). Most patients received multimodality therapy. 19 patients underwent local surgical resection. 21 patients received locoregional external beam radiotherapy (EBRT) with a median cumulative dose of 3,000 cGy and median number of fractions of 16. 14 patients received systemic therapy (n = 11 concurrent with EBRT), most commonly doxorubicin (n = 9). 16 patients were never disease free, 11 patients had disease recurrence, and 1 patient had no evidence of disease progression. Median OS was 4 months with 1-year survival of 17.9%. Regression analysis showed that EBRT (HR: 0.174; 95% CI: 0.050–0.613; p=0.007) and surgical resection (HR: 0.198; 95% CI: 0.065–0.598; p=0.004) were associated with improved OS. Administration of chemotherapy was not associated with OS. Conclusions Anaplastic thyroid cancer patients receiving EBRT to the thyroid area/neck and/or surgical resection had better OS than patients without these therapies, though selection bias likely contributed to improved outcomes since patients who can undergo these therapies tend to have better performance status. Prognosis remains poor overall, and new therapeutic approaches are needed to improve outcomes.
Highlights
Thyroid cancer is a prevalent disease that affects 5% of females and 1% of males globally [1]
In patients who received external beam radiotherapy (EBRT), intensity modulated radiation treatment (IMRT) was associated with a greater but not statistically significant 1-year survival rate (33.3%; 95% CI: 10.3–58.8%) as compared to 2D/3D conformal RT (11.1%; 95% CI: 0.6–38.8%)
The published literature on treatment of Anaplastic thyroid cancer (ATC) consists mostly of single-institution retrospective studies with some larger studies and one meta-analysis [17,18,19,20,21,22,23,24,25]. They agree with the poor prognosis of ATC, encourage consideration of stage and prognostic factors for treatment recommendations, and indicate that a combination of surgery, radiotherapy, and chemotherapy is the most effective treatment regimen for anaplastic thyroid cancer
Summary
Thyroid cancer is a prevalent disease that affects 5% of females and 1% of males globally [1]. Anaplastic thyroid cancer (ATC) is the rarest histologic subtype, representing 1-2% of thyroid malignancies with approximately 600 new cases in the U.S annually [2]. It is the most aggressive type of thyroid cancer and causes significant morbidity and mortality. Outcomes are poor with a median survival of 3-10 months and a 20%. Anaplastic thyroid cancer patients receiving EBRT to the thyroid area/neck and/or surgical resection had better OS than patients without these therapies, though selection bias likely contributed to improved outcomes since patients who can undergo these therapies tend to have better performance status. New therapeutic approaches are needed to improve outcomes
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