Anaplastic thyroid carcinoma: changing trends of treatment strategies and associated overall survival.

Autor: Wächter S; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany. seckhard@med.uni-marburg.de., Vorländer C; Department of Surgery, Bürgerhospital Frankfurt Am Main, Nibelungenallee 37-41, 60318, Frankfurt am Main, Hessen, Germany., Schabram J; Department of Surgery, Asklepios Klinik Lich, Goethestrasse 5, 35423, Lich, Hessen, Germany., Mintziras I; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany., Fülber I; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany., Manoharan J; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany., Holzer K; Section of Endocrine Surgery, Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany., Bartsch DK; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany., Maurer E; Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Baldingerstrasse, 35043, Marburg, Hessen, Germany.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2020 May; Vol. 277 (5), pp. 1507-1514. Date of Electronic Publication: 2020 Feb 14.
DOI: 10.1007/s00405-020-05853-8
Abstrakt: Purpose: The prognosis of anaplastic thyroid cancer (ATC) is poor. Despite various attempts to modify common treatment modalities, including surgery, external beam radiation (EBRT) and chemotherapy (CTX), no standardized treatment is yet established. This study aimed to analyze the changing trends of treatment concepts and associated overall survival (OS) over the last two decades.
Methods: A retrospective analysis was conducted on 42 patients with histologically confirmed ATC. The outcome measures included the evaluation of clinical characteristics and treatments performed with regard to OS.
Results: Median OS for all tumor stages was 6 (range 1 week-79) months, 6.5 months for stage IVA/B and 4 months for stage IVC carcinoma patients. Twenty-one patients with stage IVA/B carcinomas underwent curative treatment, including thyroidectomy with lymphadenectomy (TTX plus LAD, n = 11) or multimodal treatment with TTX plus LAD and EBRT plus/minus CTX (n = 10). The median OS of patients with stage IVA/B carcinomas was significantly prolonged after multimodal treatment than after surgery alone (25 vs. 3 months, p = 0.04). Fifteen of 18 patients with stage IVC carcinomas received palliative, 3 patients multimodal treatment. The median OS of stage IVC patients after trimodal therapy was not significantly longer than after debulking procedures (6 vs. 7 months, p = 0.25). In the time period 1999-2009, only 4 (21%) patients received multimodal treatment compared to 9 (39%) in the period from 2009 to 2019, but this did not result in a significantly prolonged survival in the latter period (8.5 vs. 15 months, p = 0.61).
Conclusion: Concurrent radio- and/or chemotherapy in combination with surgery seems to result in improved survival in stage IVA/B ATC, whereas this is not the case in patients with stage IVC tumors. Novel treatment regimens are urgently needed to improve the dismal prognosis of ATC.
Databáze: MEDLINE
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