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Original Investigation |

Aggressive Palliation and Survival in Anaplastic Thyroid Carcinoma

Yuval Nachalon, MD1,2; Sagit Stern-Shavit, MD1,2; Gideon Bachar, MD1,2; Jacob Shvero, MD1,2; Dror Limon, MD2,3; Aron Popovtzer, MD2,3
[+] Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3Head and Neck Tumor Unit, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1128-1132. doi:10.1001/jamaoto.2015.2332.
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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.

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Figure 1.
Overall Kaplan-Meier Survival Analysis in Patients Treated With Different Radiotherapy (RT) Protocols

Median (95% CI) survival times were 11 (8.1-13.9) months for patients receiving chemoradiotherapy (CRT), 6 (3.1-8.9) months for patients receiving aggressive palliative radiotherapy (APR), 3 (0.0-7.8) months for patients receiving palliative radiotherapy (PAR), and 1 month for patients receiving no RT.

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Figure 2.
Overall Kaplan-Meier Survival Analysis in Patients Treated With Chemotherapy

Median (95% CI) survival times were 11 (8.1-13.9) months for patients who were treated with chemotherapy and 4 (1.2-6.8) months for patients who were not.

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Figure 3.
Overall Kaplan-Meier Survival Analysis in Patients With a History of Thyroid Disease vs De Novo Disease

Median (95% CI) overall survival time was 4 (1.1-6.9) months for patients with a history of papillary thyroid carcinoma (PTC) and 9 (5.5-12.5) months for patients with de novo anaplastic thyroid carcinoma (ATC).

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