Anaplastic Thyroid Carcinoma Follow-up

  • Author: Anastasios K Konstantakos, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Feb 23, 2012
 

Further Inpatient Care

  • Role of adjuvant therapy
    • Radiotherapy: Despite the fact that anaplastic thyroid carcinoma (ATC) is largely radioresistant, use external-beam radiotherapy for local control. Some evidence shows that hyperfractionation may lead to better success at local control by permitting delivery of higher doses of total radiation with less toxicity.
      • Bhatia et al reported on the use of conformal 3-dimensional radiotherapy (3DRT) or intensity-modulated radiotherapy (IMRT) in 53 consecutive patients with anaplastic thyroid cancer. Median radiation dose was 55 Gray (Gy; range, 4-70 Gy); IMRT was given to a median 60 Gy (range, 39.9-69.0 Gy). Superior survival was noted in patients without distant metastases who received ≥ 50 Gy.[5]
    • Chemotherapy: Currently, no available chemotherapeutic agent or combination of chemotherapeutic agents shows sufficient antineoplastic activity to prevent death; yet, in rare instances, chemotherapy may prolong life by a few weeks or perhaps months. Doxorubicin and cisplatin are the 2 most common agents used; however, resistance from cellular extrusion of the drugs occurs. Valproic acid has been introduced into treatment regimens because it induces apoptosis, modulates differentiation gene expression of thyroid tumors, and enhances the sensitivity of anaplastic cancer cell lines to doxorubicin.[6]
    • A study from the Netherlands reported significantly improved local control and improved median survival with a protocol consisting of locoregional radiotherapy in 46 fractions of 1.1 Gy, given twice daily, followed by prophylactic irradiation of the lungs in 5 daily fractions of 1.5 Gy. Low-dose doxorubicin (15 mg/m2) is administered weekly during radiotherapy, followed by adjuvant doxorubicin (50 mg/m2) 3 times a week up to a cumulative dose of 550 mg/m2.[7]
  • Since ATC is a relatively uncommon disease, large phase III clinical trials of systemic therapies are not possible to perform. For that reason, the value of newer therapies, such as taxanes, gemcitabine, and irinotecan, and targeted therapies, such as receptor tyrosine kinase inhibitors, is unknown.
  • Immunohistochemical evaluation of molecular markers in ATC showed frequent and strong overexpression of beta-catenin, aurora A, cyclin E, cyclin D1, and epidermal growth factor receptor. These findings support the development of clinical trials with agents such as cetuximab, small-molecule tyrosine kinase inhibitors, and aurora kinase inhibitors.[8]
Next

Complications

  • Risk of local complications from thyroid surgery (eg, permanent hypoparathyroidism, recurrent laryngeal nerve palsy) may be increased with anaplastic thyroid carcinoma (ATC) if aggressive resection is attempted.
  • With limited thyroid resection, incidence of these local complications should not be significantly greater.
  • ATC may cause airway obstruction. Patients with impending airway obstruction who are not candidates for local resection or chemoradiation should undergo tracheostomy; interventional bronchoscopy, including Nd-YAG laser and airway stenting, is an alternative to surgery in inoperable cases.[9]
Previous
Next

Prognosis

  • Anaplastic thyroid carcinoma (ATC) typically has a rapidly progressive course. The overall 5-year survival rate is reportedly less than 10%, and most patients do not live longer than a few months after diagnosis.
  • One study has shown that patients younger than 60 years who have intrathyroidal ATC have a better prognosis than patients who are older and have distant metastases.[10]
  • A retrospective study from Korea found that age less than 60 years, tumor size less than 7 cm, and lesser extent of disease were independent predictors of lower disease-specific mortality.[11]
  • While some studies have suggested that postoperative radiotherapy may be of benefit in terms of survival, definitive prospective trials are lacking.
  • Akaishi et al conducted a review of 100 patients with ATC in a single hospital (Ito Hospital) from 1993-2009.[12] The 1-year survival were as follows:
    • Stage IVA - 72.7%
    • Stable IVB- 24.8%
    • Stable IVC - 8.2%
  • Multivariate analysis demonstrates worse prognosis with age older than 70 years, WBC count of 10,000 mcL or more, extrathyroidal invasion, and distant metastases at the time of diagnosis. Survival was significantly better if the patient received complete resection or external radiation at doses of 40 Gy or more. Prognosis remains poor among patients with ATC, but complete surgery, radiotherapy, and a combination of the 2 modalities improved the survival of patients.
  • Orita et al developed a prognostic index that can predict prognosis and assist in the early treatment of ATC.[13]
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Anastasios K Konstantakos, MD  Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

Debra J Graham, MD, is gratefully acknowledged for the contributions made to this topic.

References

  1. Neff RL, Farrar WB, Kloos RT, Burman KD. Anaplastic thyroid cancer. Endocrinol Metab Clin North Am. Jun 2008;37(2):525-38, xi. [Medline].

  2. Smallridge RC, Marlow LA, Copland JA. Anaplastic thyroid cancer: molecular pathogenesis and emerging therapies. Endocr Relat Cancer. Mar 2009;16(1):17-44. [Medline].

  3. Wong DD, Spagnolo DV, Bisceglia M, et al. Oncocytic adrenocortical neoplasms--a clinicopathologic study of 13 new cases emphasizing the importance of their recognition. Hum Pathol. Apr 2011;42(4):489-99. [Medline].

  4. Bogsrud TV, Karantanis D, Nathan MA, Mullan BP, Wiseman GA, Kasperbauer JL, et al. 18F-FDG PET in the management of patients with anaplastic thyroid carcinoma. Thyroid. Jul 2008;18(7):713-9. [Medline].

  5. Bhatia A, Rao A, Ang KK, Garden AS, Morrison WH, Rosenthal DI, et al. Anaplastic thyroid cancer: Clinical outcomes with conformal radiotherapy. Head Neck. Nov 2 2009;[Medline].

  6. Noguchi H, Yamashita H, Murakami T, Hirai K, Noguchi Y, Maruta J, et al. Successful treatment of anaplastic thyroid carcinoma with a combination of oral valproic acid, chemotherapy, radiation and surgery. Endocr J. Apr 2009;56(2):245-9. [Medline].

  7. Swaak-Kragten AT, de Wilt JH, Schmitz PI, Bontenbal M, Levendag PC. Multimodality treatment for anaplastic thyroid carcinoma--treatment outcome in 75 patients. Radiother Oncol. Jul 2009;92(1):100-4. [Medline].

  8. Wiseman SM, Masoudi H, Niblock P, Turbin D, Rajput A, Hay J, et al. Anaplastic thyroid carcinoma: expression profile of targets for therapy offers new insights for disease treatment. Ann Surg Oncol. Feb 2007;14(2):719-29. [Medline].

  9. Chiacchio S, Lorenzoni A, Boni G, Rubello D, Elisei R, Mariani G. Anaplastic thyroid cancer: prevalence, diagnosis and treatment. Minerva Endocrinol. Dec 2008;33(4):341-57. [Medline].

  10. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. Apr 1 2005;103(7):1330-5. [Medline].

  11. Kim TY, Kim KW, Jung TS, Kim JM, Kim SW, Chung KW, et al. Prognostic factors for Korean patients with anaplastic thyroid carcinoma. Head Neck. Aug 2007;29(8):765-72. [Medline].

  12. Akaishi J, Sugino K, Kitagawa W, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid. Nov 2011;21(11):1183-9. [Medline].

  13. Orita Y, Sugitani I, Amemiya T, Fujimoto Y. Prospective application of our novel prognostic index in the treatment of anaplastic thyroid carcinoma. Surgery. Dec 2011;150(6):1212-9. [Medline].

  14. Ain KB. Anaplastic thyroid carcinoma: a therapeutic challenge. Semin Surg Oncol. 1999;16:64-69. [Medline].

  15. Austin JR, el-Naggar AK, Goepfert H. Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell. Otolaryngol Clin North Am. 1996;29:611-27. [Medline].

  16. Goutsouliak V, Hay JH. Anaplastic thyroid cancer in British Columbia 1985-1999: a population-based study. Clin Oncol (R Coll Radiol). Apr 2005;17(2):75-8. [Medline].

  17. Kapp DS, LiVolsi VA, Sanders MM. Anaplastic carcinoma following well-differentiated thyroid cancer: etiological considerations. Yale J Biol Med. 1982;55:521-8.

  18. Schott M, Scherbaum WA. Immunotherapy and gene therapy of thyroid cancer. Minerva Endocrinol. Dec 2004;29(4):175-87. [Medline].

  19. Udelsman R, Lakatos E, Ladenson P. Optimal surgery for papillary thyroid carcinoma. World J Surg. 1996;20:88-93. [Medline].

  20. Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer. Jun 2005;12(2):245-62. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.