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Anaplastic Thyroid Carcinoma Treatment & Management

  • Author: Anastasios K Konstantakos, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Apr 16, 2015
 

Medical Care

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.

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Surgical Care

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.[5]

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.

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Consultations

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

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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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

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

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

Disclosure: Nothing to disclose.

Additional Contributors

Lodovico Balducci, MD Professor, Oncology Fellowship Director, Department of Internal Medicine, Division of Adult Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine

Lodovico Balducci, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians, American Geriatrics Society, American Society of Hematology, New York Academy of Sciences, American Society of Clinical Oncology, Southern Society for Clinical Investigation, International Society for Experimental Hematology, American Federation for Clinical Research, American Society of Breast Disease

Disclosure: Nothing to disclose.

Acknowledgements

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

References
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  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. 2008 Jul. 18(7):713-9. [Medline].

  5. Brignardello E, Palestini N, Felicetti F, Castiglione A, Piovesan A, Gallo M, et al. Early Surgery and Survival of Patients with Anaplastic Thyroid Carcinoma: Analysis of a Case Series Referred to a Single Institution Between 1999 and 2012. Thyroid. 2014 Sep 5. [Medline].

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