Aggressive palliation and survival in anaplastic thyroid carcinoma

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) formetastatic 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 radiotherapymay have a survival benefit in candidates for palliative treatment and may be considered for patients with extensive disease.