Anaplastic Thyroid Carcinoma Treatment & Management
- Author: Anastasios K Konstantakos, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC more...
Treatment of anaplastic thyroid carcinoma is mostly palliative. Surgical resection with adjuvant radiation therapy and chemotherapy may prolong survival somewhat and improve quality of life.
Consider patients with unresectable tumors who are in good general condition for phase I studies. Phase I trials represent the only opportunity to identify drugs with some activity against this unusual disease. These studies are available in any major cancer center, are generally financed by the industry, and may help individual patients.
See the list below:
Use surgery to obtain a definitive diagnosis when fine-needle aspiration is unsuccessful.
Perform surgery in conjunction with radiation and chemotherapy.
Protect the airway when performing surgery; thus, an early prophylactic tracheostomy may be required.
Despite the typically large size of these tumors, the extent of resection is limited when the diagnosis is made.
Rather than performing complete thyroidectomy, resect as much thyroid tissue as possible without attempting resection of all adjacent structures because of the high incidence of postoperative morbidity (eg, vocal cord paralysis, esophageal fistula).
A greater extent of resection may be associated with slightly longer survival. For example, in a study of 55 patients with stage IV-B or IV-C ATC, Brignardello et al reported that maximal debulking—macroscopically complete resection (R0, R1), or R2 resection with minimal macroscopic residual tumor—followed by adjuvant therapy, can lengthen survival and improve quality of life by preventing airway compromise.
In both stage IV-B and IV-C ATC, survival was 6.57 months with maximal debulking versus 3.25 months with partial debulking. Moreover, death secondary to local progression of tumor occurred in 21% of patients who had maximal debulking, compared with 69% of patients treated with partial debulking or no surgery.
See Thyroid Cancer Treatment Protocols for summarized information.
Involve a surgeon with experience in thyroid operations in the operative care of affected patients.
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