eMedicine Specialties > Oncology > Carcinomas of Endocrine Organs

Thyroid, Anaplastic Carcinoma: Treatment & Medication

Author: Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Coauthor(s): Debra J Graham, MD, Director of Surgical Specialties Service, Cleveland Louis Stokes VA Medical Center, Associate Program Director, Assistant Professor, Department of Surgery, Case Western Reserve University
Contributor Information and Disclosures

Updated: Apr 18, 2006

Treatment

Medical Care

  • Treatment is mostly palliative.
  • Phase I studies are as follows:
    • Consider patients with unresectable tumors who are in good general condition for phase I studies.
    • These studies are available in any major cancer center, are generally financed by the industry, and may help individual patients.
    • Phase I trials represent the only opportunity to recognize drugs of some activity in this unusual disease.

Surgical Care

  • Perform surgery in conjunction with radiation and chemotherapy.
  • Use surgery to obtain a definitive diagnosis when fine-needle aspiration is unsuccessful.
  • Protect the airway when performing surgery; thus, performing 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). Although a greater extent of resection may be associated with slightly longer survival, this hypothesis is not confirmed.

Consultations

Involve a surgeon with experience in thyroid operations in the operative care of affected patients.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Antineoplastics

Chemotherapeutic agents that may be used in advanced disease include doxorubicin and cisplatin.


Doxorubicin (Adriamycin, Rubex)

This is an antineoplastic agent of the anthracycline antibiotic class. Inhibits topoisomerase II and produces free radicals, which may cause the destruction of DNA. The combination of these 2 events can in turn inhibit the growth of neoplastic cells. In metastatic thyroid carcinoma, doxorubicin is probably the most effective antineoplastic agent.

Adult

Recommended dose can vary from 60-75 mg/m2 typically as a single rapid IV infusion; dose may be repeated after 21 d

Pediatric

Administer as in adults

May decrease phenytoin and digoxin plasma levels; phenobarbital may decrease plasma levels of doxorubicin; cyclosporine may induce coma or seizures; mercaptopurine increases toxicity of doxorubicin; cyclophosphamide increases cardiac toxicity of doxorubicin

Documented hypersensitivity; severe heart failure; cardiomyopathy; impaired cardiac function; preexisting myelosuppression

Pregnancy

D - Unsafe in pregnancy

Precautions

Myelosuppression is a major dose-limiting toxicity; leukopenia usually reaches a nadir by week 2 of therapy and recovers by week 4; stomatitis, alopecia, and gastrointestinal upset are common but usually reversible adverse effects; erythematous streaking near the site of infusion; facial flushing; conjunctivitis; lacrimation; local toxicity may occur in irradiated tissues (eg, skin, heart, lung, esophagus, gastrointestinal mucosa)
Cardiomyopathy is a well known adverse effect of anthracycline antibiotics; acute and chronic heart failure may occur; mortality rate may exceed 50%; a dose as small as 250 mg/m2 can cause myocardial toxicity; cardiac irradiation or other concomitant anthracycline administration may increase risk of cardiotoxicity; late-onset cardiac toxicity, manifesting as congestive heart failure years after treatment, may occur in both children and adults


Cisplatin (Platinol)

Inhibits DNA synthesis and, thus, cell proliferation by causing DNA crosslinks and denaturation of double helix.

Adult

Average dose: 20 mg/m2 IV qd for 5 d or 100 mg/m2 as single dose q4wk

Pediatric

Administer as in adults

Increases toxicity of bleomycin and ethacrynic acid

Documented hypersensitivity; preexisting renal insufficiency; myelosuppression; hearing impairment

Pregnancy

D - Unsafe in pregnancy

Precautions

Administer adequate hydration before and 24 h after cisplatin dosing to reduce risk of nephrotoxicity; myelosuppression, ototoxicity, nausea, and vomiting may occur; ototoxicity can be unilateral or bilateral and may be more severe in children; marked nausea and vomiting occurs in almost all patients; at high doses or after several treatment cycles, cisplatin causes peripheral neuropathy; mild-to-moderate myelosuppression may occur transiently; electrolyte disturbances, particularly hypomagnesemia secondary to renal wasting, may occur

More on Thyroid, Anaplastic Carcinoma

Overview: Thyroid, Anaplastic Carcinoma
Differential Diagnoses & Workup: Thyroid, Anaplastic Carcinoma
Treatment & Medication: Thyroid, Anaplastic Carcinoma
Follow-up: Thyroid, Anaplastic Carcinoma
References
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References

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

  2. 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].

  3. 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].

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

  5. 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].

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

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

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

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Further Reading

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Keywords

undifferentiated thyroid carcinoma, anaplastic carcinoma of the thyroid, anaplastic thyroid carcinoma, ATC, thyroid gland malignancy, anaplastic thyroid carcinoma, thyroid cancer, thyroid tumor, metastases, thyroid malignancy

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Contributor Information and Disclosures

Author

Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Disclosure: Nothing to disclose.

Coauthor(s)

Debra J Graham, MD, Director of Surgical Specialties Service, Cleveland Louis Stokes VA Medical Center, Associate Program Director, Assistant Professor, Department of Surgery, Case Western Reserve University
Debra J Graham, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, 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

John S Macdonald, MD, Professor of Medicine, New York Medical College; Chief, Division of Medical Oncology, St Vincent's Hospital and Medical Center; Medical Director, Saint Vincent's Comprehensive Cancer Center
Disclosure: Nothing to disclose.

 
 
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