Combined therapy for thyroid squamous cell carcinoma

Primary squamous cell carcinoma of the thyroid gland successfully treated with surgical resection and adjuvant chemoradiotherapy

A 57-year-old woman presented with a 3-month history of an enlarging thyroid mass causing breathlessness and dysphagia. Cross-sectional imaging showed a thyroid tumour infiltrating the trachea and abutting the oesophagus. She underwent panendoscopy, total thyroidectomy and planned tracheal resection, but due to intraoperative findings, a staged procedure was planned instead. Histological analysis revealed a poorly differentiated squamous cell carcinoma (SCC) which was positive on paired box gene 8 (PAX8) immunostaining, suggesting a diagnosis of primary thyroid SCC. She subsequently underwent total laryngectomy and bilateral neck dissections followed by radiotherapy with concurrent cisplatin chemotherapy. The patient remains disease-free 22 months after treatment. Median overall survival is 10 months for macroscopically completely resected tumours. PAX8 immunostaining is a novel technique which helps with the diagnostic challenge of distinguishing between primary thyroid SCC and SCC metastatic to the thyroid from extrathyroidal sites. Complete surgical resection with adjuvant chemoradiotherapy may result in a favourable outcome despite conflicting reports in the literature.

Primary thyroid squamous cell carcinoma: a challenging management problem

Primary thyroid squamous cell carcinoma (SCC) is a rare and highly aggressive cancer. Diagnostic work-up encompasses cervical ultrasonography, tissue biopsy and CT scan. Surgery, radiotherapy and chemotherapy are the available treatment modalities. With a mean survival rate of 7 months reported in the literature, our patient is alive 2 years after successful treatment of her advanced primary thyroid SCC with surgery and radiotherapy.

Treatment optimization and prognostic considerations for primary squamous cell carcinoma of the thyroid

Background

Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare aggressive malignancy that usually presents in an advanced stage and has a poor prognosis. Our study aimed to investigate the clinical characteristics, treatment, and prognosis of PSCCT.

Methods

We retrospectively reviewed the medical information of patients with PSCCT diagnosed from January 2006 to May 2018 at Xiangya Hospital. Survival analysis was conducted using the Kaplan-Meier method, and Log-Rank tests were performed for statistical testing.

Results

We identified 12 patients with PSCCT (nine males and three females), accounting for only 0.19% of all thyroid cancer diagnosed during this time period. The median age of these patients was 59.5 years old and their symptoms included neck masses (n=5), hoarseness (n=2), dyspnea (n=1), dysphagia (n=1) and neck pain (n=1). Four patients were in stage IVA, five were stage IVB, and three patients were stage IVC. Six patients underwent comprehensive treatment (surgery + radiotherapy or surgery + radiotherapy + chemotherapy) and the remaining patients received radiotherapy and/or chemotherapy. The 6-month survival rate was 66.7%, compared to a 1-year survival rate of 25.0%, with a median overall survival time was 10.5 months. Kaplan-Meier analysis showed that the comprehensive treatment was superior to radiotherapy and/or chemotherapy (P=0.003).

Conclusions

PSCCT is a rare type of thyroid cancer that is highly invasive and has a poor prognosis. We show that a comprehensive treatment plan can significantly improve patient survival.

Primary squamous cell carcinoma of the thyroid: Case report and systematic review of the literature

BACKGROUND

Primary squamous cell cancer (PSCC) of thyroid is a rare malignancy with poor prognosis. It is mandatory to exclude secondary involvement of the thyroid by panendoscopy, CT-scan and immunohistochemical analysis. As treatment surgery, radiation and rarely chemotherapy is employed.

METHODS

A systematic review of the literature was conducted searching medline and embase database using the medical subject headings "primary squamous cell carcinoma of thyroid" and "primary squamous cell cancer of thyroid", for articles published until April 2016 (n=1733). Of interest were the used treatment modalities and survival outcomes.

RESULTS

A total of 35 publications reporting on 50 cases including ours were finally analyzed. A curative treatment approach was described in 24 patients (48%). Additional radiotherapy, chemotherapy or radiochemotherapy was applied in 17, 7 and 7 patients respectively. Median overall survival was 6 months [range 0-48] for 47 patients. Disease free survival was only achieved in 8 patients with disease limited to the thyroid gland, complete surgical resection and additional radiotherapy or radiochemotherapy [reported median 20 months; range 12-48].

CONCLUSION

Reported disease free survival of PSCC of the thyroid was only achieved in patients with complete surgical resection in combination with adjuvant radio- and/or chemotherapy. However long term survival has not been reported in the literature yet.

Primary Squamous Cell Carcinoma of the Thyroid: A Population-Based Analysis

Objectives To analyze the epidemiology and describe the prognostic indicators of patients with primary squamous cell carcinoma of the thyroid. Study Design and Setting Retrospective cohort study based on a national database. Methods The US National Cancer Institute's SEER registry (Surveillance, Epidemiology, and End Results) was reviewed for patients with primary squamous cell carcinoma of the thyroid from 1973 to 2012. Study variables included age, sex, race, tumor size, tumor grade, regional and distant metastases, and treatment modality. Survival measures included overall survival (OS) and disease-specific survival (DSS). Results A total of 199 cases of primary squamous cell carcinoma of the thyroid were identified. Mean age at diagnosis was 68.1 years; 58.3% were female; and 79.4% were white. Following diagnosis, 46.3% of patients underwent surgery; 55.7%, radiation therapy; and 45.8%, surgery with radiation therapy. Kaplan-Meier analysis demonstrated OS and DSS of 16% and 21% at 5 years, respectively. Median survival after diagnosis was 9.1 months. Multivariate Cox regression analysis showed that predictors of OS and DSS included age ( P < .001, P < .001, respectively), tumor grade ( P < .001, P = .001), and tumor size ( P < .001, P = .001). Surgical management was a predictor of OS but not DSS. Conclusion Squamous cell carcinoma of the thyroid is a rare malignancy with a very poor prognosis. Surgical resection confers an overall survival benefit. Age, tumor grade, and tumor size are predictors of OS and DSS.

Primary squamous cell carcinoma of thyroid: a case report and review of literature

BACKGROUND

Thyroid gland lacks squamous epithelium (except in some rare situations like embroyonic remnants or in inflammatory processes); for that reason the primary squamous cell carcinoma (SCC) of thyroid is extremely rare entity, seen only in less than 1% of all thyroid malignancies and is considered almost fatal. So, far, only few case reports have been published in literature.

CASE PRESENTATION

Herein we present a 54 years old Saudi female with 3 months history of progressive neck swelling and hoarse voice, who was referred to us by her primary care physician as suspected case of anaplastic carcinoma of thyroid for radical external beam radiation therapy (EBRT). Fine Needle aspiration cytology (FNAC) revealed squamous cell carcinoma. Computed tomography (CT) neck showed 10 × 10 cm mass in left lobe of thyroid invading trachea and skin. Extensive staging work up ruled out the possibility of any primary site of SCC other than thyroid gland. Tumor was found unresectable and was referred to radiation oncology. She received palliative EBRT 30 Gy in 10 fractions. After completion of EBRT, there was progression of disease and patient died 3 months after completion of EBRT by airway compromise.

CONCLUSION

Primary SCC of thyroid is rare and aggressive entity. FNAC is reliable and effective tool for immediate diagnosis. Surgery is a curative option, but it is not always possible as most of cases present as locally advanced with adjacent organs involvement. EBRT alone was found ineffective. Aggressive combined modality (debulking surgery, radiation and chemotherapy) shall be considered for such cases.