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Ghosh A, Dagar A, Bharat RP, Sharma A, Sharma DN, Mallick S. The modern landscape of radiotherapy in thyroid malignancies. J Cancer Res Ther 2024; 20:1-8. [PMID: 38554291 DOI: 10.4103/jcrt.jcrt_816_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/21/2023] [Indexed: 04/01/2024]
Abstract
Thyroid carcinoma is the most common malignancy of the endocrine system and accounts for nearly 1.5% of all new cancer cases in India. The incidence of thyroid cancers is on the rise secondary to multiple factors including the widespread use of radiological imaging. Surgery remains the cornerstone of treatment, and radioactive iodine therapy plays a pivotal role in differentiated thyroid cancer. Radiation therapy appears to be an underutilized treatment modality. In this review, we have summarized the role of radiation in the treatment of thyroid cancer.
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Affiliation(s)
- Adrija Ghosh
- Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, Delhi, India
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2
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Wu SS, Lamarre ED, Yalamanchali A, Brauer PR, Hong H, Reddy CA, Yilmaz E, Woody N, Ku JA, Prendes B, Burkey B, Nasr C, Skugor M, Heiden K, Chute DJ, Knauf JA, Campbell SR, Koyfman SA, Geiger JL, Scharpf J. Association of Treatment Strategies and Tumor Characteristics With Overall Survival Among Patients With Anaplastic Thyroid Cancer: A Single-Institution 21-Year Experience. JAMA Otolaryngol Head Neck Surg 2023; 149:300-309. [PMID: 36757708 PMCID: PMC9912167 DOI: 10.1001/jamaoto.2022.5045] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/15/2022] [Indexed: 02/10/2023]
Abstract
Importance Survival outcomes for anaplastic thyroid cancer (ATC), the most aggressive subtype of thyroid cancers, have remained poor. However, targeted therapies and immunotherapies present new opportunities for treatment of this disease. Evaluations of survival outcomes over time with new multimodal therapies are needed for optimizing treatment plans. Objective To evaluate the association of treatment strategies and tumor characteristics with overall survival (OS) among patients with ATC. Design, Setting, and Participants This retrospective case series study evaluated the survival outcomes stratified by treatment strategies and tumor characteristics among patients with ATC treated at a tertiary level academic institution from January 1, 2000, to December 31, 2021. Demographic, tumor, treatment, and outcome characteristics were analyzed. Kaplan-Meier method and log rank test modeled OS by treatment type and tumor characteristics. Data were analyzed in May 2022. Main Outcomes and Measures Overall survival (OS). Results The study cohort comprised 97 patients with biopsy-proven ATC (median [range] age at diagnosis, 70 [38-93] years; 60 (62%) female and 85 [88%] White individuals; 59 [61%] never smokers). At ATC diagnosis, 18 (19%) patients had stage IVA, 19 (20%) had stage IVB, and 53 (55%) had stage IVC disease. BRAF status was assessed in 38 patients; 18 (47%) had BRAF-V600E variations and 20 (53%), BRAF wild type. Treatment during clinical course included surgery for 44 (45%) patients; chemotherapy, 41 (43%); definitive or adjuvant radiation therapy, 34 (RT; 35%); and targeted therapy, 28 (29%). Median OS for the total cohort was 6.5 (95% CI, 4.3-10.0) months. Inferior OS was found in patients who did not receive surgery (hazard ratio [HR], 2.12; 95% CI, 1.35-3.34; reference, received surgery), chemotherapy (HR, 3.28; 95% CI, 1.99-5.39; reference, received chemotherapy), and definitive or adjuvant RT (HR, 2.47; 95% CI, 1.52-4.02; reference, received definitive/adjuvant RT). On multivariable analysis, age at diagnosis (HR, 1.03; 95% CI, 1.01-1.06), tumor stage IVC (HR, 2.65; 95% CI, 1.35-5.18), and absence of definitive or adjuvant RT (HR, 1.90; 95% CI, 1.01-3.59) were associated with worse OS. Conclusions and Relevance This retrospective single-institution study found that lower tumor stage, younger age, and the ability to receive definitive or adjuvant RT were associated with improved OS in patients with ATC.
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Affiliation(s)
- Shannon S. Wu
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | | | | | - Philip R. Brauer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hanna Hong
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Chandana A. Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emrullah Yilmaz
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie A. Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Brian Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christian Nasr
- Department of Internal Medicine, Division of Endocrinology, University of Arizona, Phoenix
| | - Mario Skugor
- Department of Endocrinology, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Heiden
- Department of Endocrinology, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah J. Chute
- Department of Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey A. Knauf
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Shauna R. Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jessica L. Geiger
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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3
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Sherman EJ, Harris J, Bible KC, Xia P, Ghossein RA, Chung CH, Riaz N, Gunn GB, Foote RL, Yom SS, Wong SJ, Koyfman SA, Dzeda MF, Clump DA, Khan SA, Shah MH, Redmond K, Torres-Saavedra PA, Le QT, Lee NY. Radiotherapy and paclitaxel plus pazopanib or placebo in anaplastic thyroid cancer (NRG/RTOG 0912): a randomised, double-blind, placebo-controlled, multicentre, phase 2 trial. Lancet Oncol 2023; 24:175-186. [PMID: 36681089 PMCID: PMC9969528 DOI: 10.1016/s1470-2045(22)00763-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Anaplastic thyroid cancer is a rare and aggressive cancer with no standard radiotherapy-based local treatment. Based on data suggesting synergy between pazopanib and paclitaxel in anaplastic thyroid cancer, NRG Oncology did a double-blind, placebo-controlled, randomised phase 2 clinical trial comparing concurrent paclitaxel and intensity-modulated radiotherapy (IMRT) with the addition of pazopanib or placebo with the aim of improving overall survival in this patient population. METHODS Eligible patients were aged 18 years or older with a pathological diagnosis of anaplastic thyroid cancer, any TNM stage, Zubrod performance status of 0-2, no recent haemoptysis or bleeding, and no brain metastases. Patients were enrolled from 34 centres in the USA. Initially, a run-in was done to establish safety. In the randomised phase 2 trial, patients in the experimental group (pazopanib) received 2-3 weeks of weekly paclitaxel (80 mg/m2) intravenously and daily pazopanib suspension 400 mg orally followed by concurrent weekly paclitaxel (50 mg/m2), daily pazopanib (300 mg), and IMRT 66 Gy given in 33 daily fractions (2 Gy fractions). In the control group (placebo), pazopanib was replaced by matching placebo. Patients were randomly assigned (1:1) to the two treatment groups by permuted block randomisation by NRG Oncology with stratification by metastatic disease. All investigators, patients, and funders of the study were masked to group allocation. The primary endpoint was overall survival in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of study treatment. This trial is registered with Clinicaltrials.gov, NCT01236547, and is complete. FINDINGS The safety run-showed the final dosing regimen to be safe based on two out of nine participants having adverse events of predefined concern. Between June 23, 2014, and Dec 30, 2016, 89 patients were enrolled to the phase 2 trial, of whom 71 were eligible (36 in the pazopanib group and 35 in the placebo group; 34 [48%] males and 37 [52%] females). At the final analysis (data cutoff March 9, 2020), with a median follow-up of 2·9 years (IQR 0·002-4·0), 61 patients had died. Overall survival was not significantly improved with pazopanib versus placebo, with a median overall survival of 5·7 months (95% CI 4·0-12·8) in the pazopanib group versus 7·3 months (4·3-10·6) in the placebo group (hazard ratio 0·86, 95% CI 0·52-1·43; one-sided log-rank p=0·28). 1-year overall survival was 37·1% (95% CI 21·1-53·2) in the pazopanib group and 29·0% (13·2-44·8) in the placebo group. The incidence of grade 3-5 adverse events did not differ significantly between the treatment groups (pazopanib 88·9% [32 of 36 patients] and placebo 85·3% [29 of 34 patients]; p=0·73). The most common clinically significant grade 3-4 adverse events in the 70 eligible treated patients (36 in the pazopanib group and 34 in the placebo group) were dysphagia (13 [36%] vs 10 [29%]), radiation dermatitis (8 [22%] vs 13 [38%]), increased alanine aminotransferase (12 [33%] vs none), increased aspartate aminotransferase (eight [22%] vs none), and oral mucositis (five [14%] vs eight [24%]). Treatment-related serious adverse events were reported for 16 (44%) patients on pazopanib and 12 (35%) patients on placebo. The most common serious adverse events were dehydration and thromboembolic event (three [8%] each) in patients on pazopanib and oral mucositis (three [8%]) in those on placebo. There was one treatment-related death in each group (sepsis in the pazopanib group and pneumonitis in the placebo group). INTERPRETATION To our knowledge, this study is the largest randomised anaplastic thyroid cancer study that has completed accrual showing feasibility in a multicenter NCI National Clinical Trials Network setting. Although no significant improvement in overall survival was recorded in the pazopanib group, the treatment combination was shown to be feasible and safe, and hypothesis-generating data that might warrant further investigation were generated. FUNDING National Cancer Institute and Novartis.
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Affiliation(s)
- Eric J Sherman
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | | | - Ping Xia
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ronald A Ghossein
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Nadeem Riaz
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G Brandon Gunn
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sue S Yom
- Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Michael F Dzeda
- Christiana Care Health System-Helen F Graham Cancer Center & Research Institute, Newark, DE, USA
| | | | - Saad A Khan
- UT Southwestern Harold C Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Manisha H Shah
- Ohio State University Comprehensive Cancer Center, OSU Wexner Medical Center, Columbus, OH, USA
| | - Kevin Redmond
- Radiation Oncology, University of Cincinnati-Barrett Cancer Center, Cincinnati, OH, USA
| | - Pedro A Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Quynh-Thu Le
- Stanford Cancer Institute Palo Alto, Stanford, CA, USA
| | - Nancy Y Lee
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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Gao RW, Foote RL, Garces YI, Ma DJ, Neben-Wittich M, Routman DM, Patel SH, Ko SJ, McGee LA, Bible KC, Chintakuntlawar AV, Ryder M, Morris JC, Van Abel KM, Rivera M, Abraha F, Lester SC. Outcomes and Patterns of Recurrence for Anaplastic Thyroid Cancer Treated with Comprehensive Chemoradiotherapy. Pract Radiat Oncol 2021; 12:113-119. [PMID: 34715395 DOI: 10.1016/j.prro.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE/OBJECTIVES Radiotherapy (RT) plays an important role in locoregional tumor control for anaplastic thyroid cancer (ATC). Due to its rarity, RT guidelines for ATC are lacking. We describe ATC patterns of nodal disease at presentation and progression and propose corresponding RT target volumes. MATERIALS/METHODS We identified all patients with ATC treated at our institution with definitive or adjuvant IMRT and concomitant chemotherapy from 2006 to 2020. We identified in-field, marginal, and out-of-field sites of locoregional recurrence and progression (LRR). RESULTS Forty-seven patients met inclusion. Median follow-up was 6.6 months (IQR: 1.9-19.6). Nodal levels involved at presentation included: IB (2.1%), II (23.4%), III (21.3%), IV (21.3%), V (12.8%), VI (34%), and mediastinal (6.4%). All patients received elective nodal RT to levels II-IV and VI. RT volumes also included: IA (23.4%), IB (44.7%), V (87.2%), retropharyngeal/retrostyloid (RP/RS) (27.7%), and mediastinal 1-6 (53.2%). Cumulative incidence of LRR at 3- and 12-months was 26.1% (95% CI: 15.9-42.8) and 35.7% (23.9-53.4). Isolated LRR risk at 3- and 12-months was 6.5% (2.2-19.8) and 8.9% (3.4-22.9). Fourteen (29.8%) patients experienced in-field LRR in the thyroid gland or postoperative tumor bed, II-IV, VI, and mediastinal 1 and 3A. Four (8.5%) patients had marginal LRRs, 3 of whom progressed in the mediastinum at 2, 3P, 4, and 6. Two (4.3%) patients experienced out-of-field LRRs. Throughout the pre-treatment and follow-up period, no patients had disease at IA and 1 (2.1%) patient each had disease at IB and RP/RS. No baseline or treatment characteristics, including RT dose (stratified by < or ≥66 Gy), were significant predictors of LRR on univariate analysis. CONCLUSIONS Isolated LRR risk in patients with ATC treated with comprehensive RT and chemotherapy is low. Aggressive multimodality therapy should be reserved for willing, fit patients with no or limited distant disease burden. When treating comprehensively, complete inclusion of mediastinal levels 1-6 may be warranted to avoid marginal disease progression. Omission of levels I and RP/RS can be considered.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | | | | | - Feven Abraha
- Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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5
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Allegri L, Domenis R, Navarra M, Celano M, Russo D, Capriglione F, Damante G, Baldan F. Dihydrotanshinone exerts antitumor effects and improves the effects of cisplatin in anaplastic thyroid cancer cells. Oncol Rep 2021; 46:204. [PMID: 34318905 DOI: 10.3892/or.2021.8155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/08/2021] [Indexed: 11/06/2022] Open
Abstract
Anaplastic thyroid cancer (ATC) is the most aggressive type of thyroid cancer and is responsible for 20‑50% of thyroid cancer‑associated deaths. The absence of response to conventional treatments makes the search for novel therapeutics a clinical challenge. In the present study, the effects of 15,16‑dihydrotanshinone I (DHT), a tanshinone extracted from Salvia miltiorrhiza Bunge (Danshen), which has previously been shown to possess anticancer activity, were examined in two human ATC cell lines. DHT significantly reduced cell viability, which was coupled with an increase in apoptosis. DHT administration also reduced the colony‑forming ability and proliferation of these cells in soft agar and downregulated the expression of epithelial‑to‑mesenchymal transition‑related genes. In addition, DHT significantly reduced MAD2 expression, a target of HuR with a relevant role in ATC. Finally, cotreatment with cisplatin and DHT has a greater effect on cell viability than each compound alone. In conclusion, to the best of our knowledge, the present study is the first to demonstrate that DHT exerts antitumor effects on ATC cells by reducing MAD2 expression levels. Moreover, a synergistic effect of DHT with cisplatin was shown. Further in vivo studies are required to assess this phytochemical compound as a potential adjuvant for the treatment of ATC.
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Affiliation(s)
- Lorenzo Allegri
- Department of Medicine, University of Udine, I‑33100 Udine, Italy
| | - Rossana Domenis
- Department of Medicine, University of Udine, I‑33100 Udine, Italy
| | - Michele Navarra
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, I‑98122 Messina, Italy
| | - Marilena Celano
- Department of Health Sciences, University of Catanzaro 'Magna Graecia', I‑88100 Catanzaro, Italy
| | - Diego Russo
- Department of Health Sciences, University of Catanzaro 'Magna Graecia', I‑88100 Catanzaro, Italy
| | - Francesca Capriglione
- Department of Health Sciences, University of Catanzaro 'Magna Graecia', I‑88100 Catanzaro, Italy
| | - Giuseppe Damante
- Department of Medicine, University of Udine, I‑33100 Udine, Italy
| | - Federica Baldan
- Department of Medicine, University of Udine, I‑33100 Udine, Italy
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6
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Jonker PKC, Turchini J, Kruijff S, Lin JF, Gill AJ, Eade T, Aniss A, Clifton-Bligh R, Learoyd D, Robinson B, Tsang V, Glover A, Sidhu S, Sywak M. Multimodality Treatment Improves Locoregional Control, Progression-Free and Overall Survival in Patients with Anaplastic Thyroid Cancer: A Retrospective Cohort Study Comparing Oncological Outcomes and Morbidity between Multimodality Treatment and Limited Treatment. Ann Surg Oncol 2021; 28:7520-7530. [PMID: 34032961 DOI: 10.1245/s10434-021-10146-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with anaplastic thyroid cancer (ATC) have poor overall survival, and the optimal management approach remains unclear. The aim of this study is to evaluate our experience with multimodality (MMT) versus limited treatment (LT) for ATC. PATIENTS AND METHODS A cohort study of patients with ATC managed in a tertiary referral center was undertaken. The outcomes of MMT were compared with those of LT. The primary outcome measures were locoregional control and progression-free and overall survival. Secondary outcome measures were treatment-related complications and factors associated with improved survival. RESULTS In total, 59 patients (35 females) with a median age of 73 years (range 39-99 years) and ATC stage IVA (n = 2), IVB (n = 28), or IVC (n = 29) were included. LT was utilized in 25 patients (42%), and 34 cases had MMT. MMT patients had a longer time of locoregional control (18.5 versus 1.9 months; p < 0.001), progression-free survival (3.5 versus 1.2 months; p < 0.001), and overall survival (6.9 versus 2.0 months; p < 0.001) when compared with LT. For patients with stage IVC ATC, locoregional control (p = 0.03), progression-free survival (p < 0.001), and overall survival (p < 0.001) were superior in the MMT cohort compared with LT. MMT had more treatment-related complications than LT (p < 0.001). An Eastern Cooperative Oncology Group performance status < 2 (HR 0.30; p = 0.001) and MMT (HR 0.35; p = 0.008) were associated with improved overall survival. CONCLUSION MMT is likely to improve locoregional control, progression-free survival, and overall survival in selected ATC patients including stage IVC tumors but comes with a greater complication risk.
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Affiliation(s)
- Pascal K C Jonker
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John Turchini
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.,Discipline of Pathology, MQ Health, Macquarie University, Macquarie Park, NSW, Australia
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jia Feng Lin
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony J Gill
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,NSW Health Pathology Department of Anatomical Pathology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Cancer Diagnsosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Thomas Eade
- Department of Radiation Oncology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Ahmad Aniss
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Roderick Clifton-Bligh
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Diana Learoyd
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Bruce Robinson
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Venessa Tsang
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
| | - Anthony Glover
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Endocrine Cancer Program, Cancer Theme, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, 2052, Australia
| | - Stanley Sidhu
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Sywak
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia. .,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,University of Sydney Endocrine Surgery Unit, AMA House, St Leonards, NSW, 2065, Australia.
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7
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Bible KC, Kebebew E, Brierley J, Brito JP, Cabanillas ME, Clark TJ, Di Cristofano A, Foote R, Giordano T, Kasperbauer J, Newbold K, Nikiforov YE, Randolph G, Rosenthal MS, Sawka AM, Shah M, Shaha A, Smallridge R, Wong-Clark CK. 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid 2021; 31:337-386. [PMID: 33728999 PMCID: PMC8349723 DOI: 10.1089/thy.2020.0944] [Citation(s) in RCA: 279] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Since the guidelines for the management of ATC by the American Thyroid Association were first published in 2012, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, and researchers on published evidence relating to the diagnosis and management of ATC. Methods: The specific clinical questions and topics addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of the Task Force members (authors of the guideline). Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, targeted/systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues, including end of life. The guidelines include 31 recommendations and 16 good practice statements. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of ATC. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with ATC.
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Affiliation(s)
- Keith C. Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Electron Kebebew
- Stanford University, School of Medicine, Stanford, California, USA
| | - James Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Juan P. Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Antonio Di Cristofano
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert Foote
- Department of Radiation Oncology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Thomas Giordano
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jan Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - M. Sara Rosenthal
- Program for Bioethics and Markey Cancer Center Oncology Ethics Program, Departments Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Anna M. Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| | - Manisha Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Ashok Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Hypofractionated Radiotherapy for Anaplastic Thyroid Cancer: Systematic Review and Pooled Analysis. Cancers (Basel) 2020; 12:cancers12092506. [PMID: 32899355 PMCID: PMC7563200 DOI: 10.3390/cancers12092506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Anaplastic thyroid carcinoma is an aggressive cancer subtype with a dismal prognosis. Multimodal treatment approaches consisting of surgical resection, radiation therapy (RT) and chemotherapy have resulted in longer overall survival and promising outcomes. Hypofractionated RT is an alternative to conventional RT regimens. In this study, we aim to evaluate the outcome of hypofractionated regimens, perform a systematic review concerning hypofractionated RT and pooled analysis of this treatment modality. Hypofractionated RT appears to be non-inferior compared to conventional RT concerning OS after propensity score matching. In addition, radiation dose escalation correlated with a longer OS. In conclusion, hypofractionated RT is effective with manageable toxicity and could be an integral part in multimodal treatment. Abstract Anaplastic thyroid carcinoma (ATC) is associated with a poor prognosis due to aggressive tumor growth and high treatment resistance. Hypofractionated treatment concepts may be more effective and less time consuming compared to normofractionated radiotherapy (RT). In this retrospective study, we aim to evaluate the outcome of hypofractionated regimens and perform a systematic review concerning hypofractionated RT and pooled analysis of this treatment modality. A systematic review using the MEDLINE/Pubmed and Cochrane databases was performed. Data from all eligible studies were extracted, and a pooled analysis of literature and our cohort (n = 60) was carried out to examine patient characteristics, toxicity, and outcomes of patients with ATC. As a result, median overall survival (OS) of the single center cohort was four (range 1–12) months. Survival rates at one, three, and six months were 82%, 55%, and 36%, respectively. In univariate analyses, multimodal treatment (p = 0.006) and gender (p = 0.04) were correlated with an improved OS. Six studies with a total number of 152 patients undergoing hypofractionated RT treatment were analyzed. The pooled analysis included four patient cohorts with 60 patients and showed median OS of 5.3 (range: 1–24) months. Multimodal treatment (p < 0.001) and a cumulative radiation dose ≥50 Gy in equivalent dose in 2 Gy fractions (EQD2) (p = 0.014) correlated with an improved OS. On multivariate analysis, multimodal treatment (p = 0.003, hazard ratio (HR): 0.636, 95% confidence interval (CI): 0.469–0.861) was an independent predictor for longer OS. After propensity score matching (PSM), hypofractionated RT appears to be non-inferior compared to normofractionated RT concerning OS. In conclusion, hypofractionated RT is effective with manageable toxicity. A dose escalation with ≥50 Gy (EQD2) correlated with a longer OS. Hypofractionated RT could be an integral part in multimodal treatment with a promising outcome.
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Chintakuntlawar AV, Yin J, Foote RL, Kasperbauer JL, Rivera M, Asmus E, Garces NI, Janus JR, Liu M, Ma DJ, Moore EJ, Morris JC, Neben-Wittich M, Price DL, Price KA, Ryder M, Van Abel KM, Hilger C, Samb E, Bible KC. A Phase 2 Study of Pembrolizumab Combined with Chemoradiotherapy as Initial Treatment for Anaplastic Thyroid Cancer. Thyroid 2019; 29:1615-1622. [PMID: 31595822 DOI: 10.1089/thy.2019.0086] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Anaplastic thyroid cancer (ATC) has poor prognosis with median overall survival (OS) of ∼6 months. We previously reported high PD-1/PDL-1 staining in ATC, raising the possibility of the productive application of the immunotherapeutic pembrolizumab. However, having found pembrolizumab to anecdotally have limited single-agent activity in ATC, we sought to alternatively define whether pembrolizumab might synergistically combine with chemoradiotherapy as initial ATC therapy. Methods: An investigator-initiated therapeutic phase 2 trial of pembrolizumab, 200 mg intravenously (IV) every 3 weeks, combined with chemoradiotherapy (docetaxel/doxorubicin, 20 mg/m2 each IV weekly plus volumetric modulated arc therapy) was initiated as frontline therapy (with or without surgery) in ATC to assess efficacy and toxicities. Six-month OS was selected as the primary endpoint using a Simon's optimal design with interim analysis (targeting accrual of 25 patients; Cohort A: prior resection, Cohort B: no resection). Based on a prior patient cohort-treated similarly, but without pembrolizumab, the design was such that, if 6-month true survival is 75%, the probability of declaring the approach worthy of further pursuit would be 91%. Results: Three patients were enrolled, two with rapidly enlarging unresectable neck masses. Early tumor responses were favorable in all three, and all three satisfactorily completed: intended radiotherapy, preceding and radiotherapy-concurrent pembrolizumab, and concurrent chemoradiotherapy. However, all three patients died <6 months following therapy initiation-one from pulmonary metastases and two from otherwise unexpected fatal pulmonary complications occurring subsequent to chemoradiotherapy completion-prompting study closure. Conclusions: Although initially tolerated and effective in terms of locoregional disease control, disappointing survival outcomes compared with historical controls raise uncertainty that the piloted approach merits further pursuit in ATC.
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Affiliation(s)
| | - Jun Yin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Rivera
- Department of Laboratory and Anatomical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Erik Asmus
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nina I Garces
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Minetta Liu
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John C Morris
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel L Price
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Crystal Hilger
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eleyna Samb
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Chintakuntlawar AV, Foote RL, Kasperbauer JL, Bible KC. Diagnosis and Management of Anaplastic Thyroid Cancer. Endocrinol Metab Clin North Am 2019; 48:269-284. [PMID: 30717908 DOI: 10.1016/j.ecl.2018.10.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anaplastic thyroid cancer (ATC) is a devastating and usually incurable diagnosis. Clinical and pathologic diagnosis is best assessed at a tertiary center with concentrated ATC expertise. Expeditious multidisciplinary management is recommended for optimal patient outcomes. Based on multiinstitutional and population-based studies, multimodal therapy that includes chemoradiotherapy with surgery (when feasible) is the preferred initial treatment because it is associated with incrementally improved overall survival. In ATC that carries a BRAF V600E somatic mutation, combination therapy with BRAF and MEK inhibitors has shown promise but needs further study. Immunotherapeutic agents in neoadjuvant and metastatic settings are being investigated.
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Affiliation(s)
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jan L Kasperbauer
- Division of Head and Neck Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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11
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Park JW, Choi SH, Yoon HI, Lee J, Kim TH, Kim JW, Lee IJ. Treatment outcomes of radiotherapy for anaplastic thyroid cancer. Radiat Oncol J 2018; 36:103-113. [PMID: 29983030 PMCID: PMC6074067 DOI: 10.3857/roj.2018.00045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/29/2018] [Indexed: 11/03/2022] Open
Abstract
Purpose Anaplastic thyroid cancer (ATC) is a rare tumor with a lethal clinical course despite aggressive multimodal therapy. Intensity-modulated radiotherapy (IMRT) may achieve a good therapeutic outcome in ATC patients, and the role of IMRT should be assessed. We retrospectively reviewed outcomes for ATC treated with three-dimensional conformal radiotherapy (3D-CRT) or IMRT to determine the optimal treatment option and explore the role of radiotherapy (RT). Materials and Methods Between December 2000 and December 2015, 41 patients with pathologically proven ATC received RT with a sufficient dose of ≥40 Gy. Among them, 21 patients (51%) underwent surgery before RT. Twenty-eight patients received IMRT, and 13 received 3D-CRT. Overall survival (OS) and progression-free survival (PFS), patterns of failure, and toxicity were examined. Results The median follow-up time for survivors was 38.0 months. The median and 1-year OS and PFS rates were 7.2 months and 29%, 4.5 months and 15%, respectively. Surgery significantly improved the prognosis (median OS: 10.7 vs. 3.9 months, p = 0.001; median PFS: 5.9 vs. 2.5 months, p = 0.007). IMRT showed significantly better PFS and OS than 3D-CRT, even in multivariate analysis (OS: hazard ratio [HR] = 0.30, p = 0.005; PFS: HR = 0.33, p = 0.005). Significantly higher radiation dose could be delivered with IMRT than 3D-CRT (EQD210 66 vs. 60 Gy, p = 0.005). Only 2 patients had grade III dermatitis after IMRT. No other severe toxicity ≥grade III occurred. Conclusion Patients with ATC showed better prognosis through multimodal treatment. Furthermore, IMRT could achieve favorable survival rates by safely delivering higher dose than 3D-CRT.
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Affiliation(s)
- Jong Won Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Incheon, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Hvilsom GB, Londero SC, Hahn CH, Schytte S, Pedersen HB, Christiansen P, Kiss K, Larsen SR, Jespersen ML, Lelkaitis G, Godballe C. Anaplastic thyroid carcinoma in Denmark 1996-2012: A national prospective study of 219 patients. Cancer Epidemiol 2018; 53:65-71. [PMID: 29414634 DOI: 10.1016/j.canep.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC) is the least common but most malignant thyroid cancer. We aimed to examine the characteristics as well as evaluate the incidence, prognostic factors, and if introduction of a fast track cancer program might influence survival in a cohort of ATC patients. METHODS A cohort study based on prospective data from the national Danish thyroid cancer database DATHYRCA and the national Danish Pathology Register including 219 patients diagnosed from 1996 to 2012, whom were followed until death or through September 2014. RESULTS We found the median age in the 7th decade, the majority of patients being women presenting with a growing mass at the neck, diagnosed with stage T4b disease. At diagnosis, 56% of the patients had lymph node metastasis and 38% distant metastasis. We observed one- and five-year survival of 20.7% and 11.0%, respectively. Both univariate and multivariate analyses showed age (above 73.6 years), respiratory impairment, T4b stage, and distant metastasis at diagnosis to be significant prognostic factors. Further, introduction of a national fast track cancer program increased survival nearly two-fold. CONCLUSION As new information, our study adds "respiratory impairment at diagnosis" and "introduction of a national fast track cancer program" to the list of already established prognostic indicators for ATC.
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Affiliation(s)
- Gitte Bjørn Hvilsom
- Odense University Hospital, Department of ENT, Head & Neck Surgery, Sdr Boulevard 29, 5000 Odense C, Denmark.
| | - Stefano Christian Londero
- Odense University Hospital, Department of ENT, Head & Neck Surgery, Sdr Boulevard 29, 5000 Odense C, Denmark; Aarhus University Hospital, Department of ENT Head & Neck Surgery, Nørrebrogade 44, 8000 Aarhus C, Denmark.
| | - Christoffer Holst Hahn
- Copenhagen University Hospital, Rigshospitalet, Department of ENT Head & Neck Surgery, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Sten Schytte
- Aarhus University Hospital, Department of ENT Head & Neck Surgery, Nørrebrogade 44, 8000 Aarhus C, Denmark.
| | - Henrik Baymler Pedersen
- Aalborg University Hospital, Syd, Department of ENT Head & Neck Surgery, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Peer Christiansen
- Aarhus University Hospital, Department of Surgery, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Katalin Kiss
- Copenhagen University Hospital, Rigshospitalet, Department of Pathology, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Stine Rosenkilde Larsen
- Odense University Hospital, Department of Pathology, Sdr Boulevard 29, 5000 Odense C, Denmark.
| | - Marie Louise Jespersen
- Aarhus University Hospital, Department of Pathology, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Giedrius Lelkaitis
- Aalborg University Hospital, Nord, Department of Pathology, Ladegårdsgade 3, 9000 Aalborg, Denmark.
| | - Christian Godballe
- Odense University Hospital, Department of ENT, Head & Neck Surgery, Sdr Boulevard 29, 5000 Odense C, Denmark.
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Prasongsook N, Kumar A, Chintakuntlawar AV, Foote RL, Kasperbauer J, Molina J, Garces Y, Ma D, Wittich MAN, Rubin J, Richardson R, Morris J, Hay I, Fatourechi V, McIver B, Ryder M, Thompson G, Grant C, Richards M, Sebo TJ, Rivera M, Suman V, Jenkins SM, Smallridge RC, Bible KC. Survival in Response to Multimodal Therapy in Anaplastic Thyroid Cancer. J Clin Endocrinol Metab 2017; 102:4506-4514. [PMID: 29029287 DOI: 10.1210/jc.2017-01180] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. OBJECTIVE To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival. DESIGN MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999. PATIENTS Forty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT. MAIN OUTCOME MEASURE Overall survival (OS) and progression-free survival determined by Kaplan-Meier method. RESULTS Median OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy. CONCLUSION MMT appears to convey longer survival in ATC among patients with stage IVA/B disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic
| | | | | | | | | | - Ian Hay
- Division of Endocrinology, Mayo Clinic
| | | | | | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic
- Division of Endocrinology, Mayo Clinic
| | | | | | | | - Thomas J Sebo
- Department of Laboratory and Anatomical Pathology, Mayo Clinic
| | - Michael Rivera
- Department of Laboratory and Anatomical Pathology, Mayo Clinic
| | - Vera Suman
- Division of Biomedical Statistics and Informatics, Mayo Clinic
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic
| | - Robert C Smallridge
- Division of Endocrinology, Mayo Clinic
- Endocrine Malignancies Disease Oriented Group, Mayo Clinic Cancer Center
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14
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Chintakuntlawar AV, Rumilla KM, Smith CY, Jenkins SM, Foote RL, Kasperbauer JL, Morris JC, Ryder M, Alsidawi S, Hilger C, Bible KC. Expression of PD-1 and PD-L1 in Anaplastic Thyroid Cancer Patients Treated With Multimodal Therapy: Results From a Retrospective Study. J Clin Endocrinol Metab 2017; 102:1943-1950. [PMID: 28324060 DOI: 10.1210/jc.2016-3756] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/01/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT Anaplastic thyroid cancer (ATC) is rare and a highly fatal malignancy. The role of programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) as prognostic and/or predictive markers in ATC is unknown. OBJECTIVE Multimodal therapy offers the best chance at tumor control. The objective of this study was to detect potential associations of PD-1/PD-L1 axis variables with outcome data in ATC. DESIGN Retrospective study of a uniformly treated cohort. SETTING Single institution retrospective cohort study. PATIENTS OR OTHER PARTICIPANTS Sixteen patients who received intensity-modulated radiation therapy (15 had preceding surgery) were studied. MAIN OUTCOME MEASURE Patients treated with multimodal therapy were followed and assessed for overall survival (OS) and progression-free survival (PFS). RESULTS All samples demonstrated PD-1 expression in inflammatory cells whereas tumor cells were primarily negative. PD-L1 was expressed on ATC tumor cells in most samples and showed mainly membranous staining. High PD-1 expression (>40% staining) in inflammatory cells was associated with worse overall survival (OS; hazard ratio, 3.36; 95% confidence interval, 1.00 to 12.96; P < 0.05) and trended toward worse PFS, whereas high PD-L1 expression in tumor cells (>33% staining) trended toward worse PFS and OS. CONCLUSION PD-1/PD-L1 pathway proteins are highly expressed in ATC tumor samples and appear to represent predictive markers of PFS and OS in multimodality-treated ATC patients.
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Affiliation(s)
| | - Kandelaria M Rumilla
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Carin Y Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Sarah M Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905
| | - John C Morris
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905
| | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905
| | - Samer Alsidawi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905
| | - Crystal Hilger
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
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15
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Kwon J, Kim BH, Jung HW, Besic N, Sugitani I, Wu HG. The prognostic impacts of postoperative radiotherapy in the patients with resected anaplastic thyroid carcinoma: A systematic review and meta-analysis. Eur J Cancer 2016; 59:34-45. [PMID: 27014798 DOI: 10.1016/j.ejca.2016.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/07/2016] [Accepted: 02/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optimal postoperative managements for anaplastic thyroid carcinoma (ATC) have not yet been sufficiently clarified. We conducted a systematic review and meta-analysis focussing on the impact of postoperative radiotherapy (PORT) in the patients with resected ATC. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive search was performed in the several databases. We included the studies that reported survival outcome in the patients with or without PORT following any type of surgical resection except biopsy only. Hazard ratio (HR) was extracted, and the random-effects model was used for the pooled analysis. RESULTS Seventeen retrospective studies including 1147 analysable patients met all inclusion criteria. The overall research quality was relatively low with considerable methodological limitations. The pooled results showed that PORT significantly reduced the risk of death in all the patients with resected ATC compared with those with surgery alone (HR, 0.556; 95% confidence interval, 0.419-0.737; p < 0.001). Exploratory analyses demonstrated that patients with stage IVA (HR, 0.364; p = 0.012) and IVB (HR, 0.460; p = 0.059) may also have survival benefit from PORT, whereas stage IVC may not. No evidence of publication bias was found (p = 0.352). CONCLUSIONS This study is the first meta-analysis assessing PORT in patients with ATC and provides convincing evidence that adequate resection followed by PORT may offer the prolonged survival. However, without evidence based on prospective randomised trials, it is still not known which subset of patients can really benefit from PORT.
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Affiliation(s)
- Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byoung Hyuck Kim
- Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, Republic of Korea.
| | - Hee-Won Jung
- Geriatric Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan; Anaplastic Thyroid Carcinoma Research Consortium of Japan, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
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16
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Lee DY, Won JK, Lee SH, Park DJ, Jung KC, Sung MW, Wu HG, Kim KH, Park YJ, Hah JH. Changes of Clinicopathologic Characteristics and Survival Outcomes of Anaplastic and Poorly Differentiated Thyroid Carcinoma. Thyroid 2016; 26:404-13. [PMID: 26541309 DOI: 10.1089/thy.2015.0316] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study aimed to analyze the temporal changes of the clinicopathologic characteristics, and the long-term outcomes, of various types of anaplastic thyroid cancer (ATC) and poorly differentiated thyroid cancer (PDTC). METHODS A retrospective analysis was conducted on patients with ATC and PDTC who were treated from 1985 to 2013. The outcome measures included the clinical response to treatment and the survival rates of three separate thyroid cancer groups: ATC, PDTC, and differentiated thyroid cancer (DTC) with anaplastic foci. RESULTS The five-year disease-specific survival rate was significantly higher, both in DTC with anaplastic foci and in PTDC (81.3% and 65.8%, respectively), than it was in ATC (14.3%; p < 0.001). The proportion of cases of DTC with anaplastic foci has been increasing over time, while that of ATC has decreased. The survival rate was found to be significantly higher in resectable tumors (71.4% and 26.5%, respectively; p < 0 .001). In ATC, external beam radiation therapy showed longer survival rates than did surgery-based treatment in unresectable tumors (19.2 vs. 7.7 months, p = 0.006). Adjuvant treatment with external beam radiation or radioactive iodine increased survival duration in PDTC and in DTC with anaplastic foci. Lymphatic invasion was the most significant postoperative prognosticator in ATC (p = 0.013). CONCLUSIONS The choice of treatment of ATC and PDTC could be modified according to resectability and lymphatic invasion of the cancer.
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Affiliation(s)
- Doh Young Lee
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine , Seoul, Korea
| | - Jae-Kyung Won
- 2 Department of Pathology, Seoul National University College of Medicine , Seoul, Korea
| | - Se-Hoon Lee
- 3 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Do Joon Park
- 4 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - Kyeong Cheon Jung
- 2 Department of Pathology, Seoul National University College of Medicine , Seoul, Korea
| | - Myung-Whun Sung
- 5 Department of Otorhinolaryngology-Head and Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
| | - Hong-Gyun Wu
- 6 Department of Radiation Oncology, Seoul National University College of Medicine , Seoul, Korea
| | - Kwang Hyun Kim
- 5 Department of Otorhinolaryngology-Head and Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
| | - Young Joo Park
- 4 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Korea
| | - J Hun Hah
- 5 Department of Otorhinolaryngology-Head and Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea
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Lennon P, Deady S, Healy ML, Toner M, Kinsella J, Timon CI, O'Neill JP. Anaplastic thyroid carcinoma: Failure of conventional therapy but hope of targeted therapy. Head Neck 2016; 38 Suppl 1:E1122-9. [PMID: 26879282 DOI: 10.1002/hed.24170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anaplastic thyroid cancer has a median survival between 1.2 and 10 months. The purpose of our study was to evaluate the outcomes of patients with anaplastic thyroid cancer in Ireland. METHODS We carried out a retrospective analysis of the Irish National Cancer Database for patients with anaplastic thyroid cancer between 2000 and 2010. RESULTS Of a total of 64 patients (40 women, 24 men), the median age was 69 years, and 29.7% of the patients had distant metastases. The overall median survival was 2.3 months and the 1, 2, and 5-year survival was 12.5%, 6.25%, and 4.69%, respectively. On univariate analysis age, sex, metastases at diagnosis, and multimodality treatment were statistically significant indicators of prognosis, and metastases at diagnosis remained statistically significant on multivariate analysis. CONCLUSION These results correlate with the American Thyroid Association (ATA) guidelines, in which, when possible, multimodality therapy offers a survival advantage to a select group of patients. Novel therapies may offer the greatest hope for these patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1122-E1129, 2016.
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Affiliation(s)
- Paul Lennon
- Department of Otolaryngology, Head and Neck Surgery, St. James's Hospital, Dublin, Ireland
| | - Sandra Deady
- National Cancer Registry - Ireland, Cork, Ireland
| | - Maire L Healy
- Department of Endocrinology, St. James's Hospital, Dublin, Ireland
| | - Mary Toner
- Department of Histopathology, St. James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology, Head and Neck Surgery, St. James's Hospital, Dublin, Ireland
| | - Conrad I Timon
- Department of Otolaryngology, Head and Neck Surgery, St. James's Hospital, Dublin, Ireland
| | - James P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Revannasiddaiah S, Madabhavi I, Bodh A, Thakur P, Sharma M. Metronomic chemotherapy in anaplastic thyroid carcinoma: a potentially feasible alternative to therapeutic nihilism. Indian J Palliat Care 2015; 21:245-9. [PMID: 26009682 PMCID: PMC4441190 DOI: 10.4103/0973-1075.156511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies and prognostic outlook remains very dismal. Treatment most often is palliative in intent attempting to relieve the patients from local compressive symptoms in the neck. Radical surgery, radiotherapy (RT), and chemotherapy have not been tested in large prospective trials, and current evidence from retrospective series and small trials indicate only marginal survival benefits. Given the poor prognostic and therapeutic outlook, patients must be encouraged to be actively involved in the decision making process. We report the case of an elderly patient who had no response to palliative RT, and was treated with oral metronomic chemotherapy. The response to oral metronomic chemotherapy was dramatic, and the patient has enjoyed complete freedom from symptoms as well as radiologically exhibits a complete regression. Thus, we document the first ever use of a simple, cost-effective, and convenient oral metronomic chemotherapeutic regimen delivering a remarkable response in an elderly patient with ATC.
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Affiliation(s)
- Swaroop Revannasiddaiah
- Department of Radiotherapy, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Irappa Madabhavi
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Anita Bodh
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Priyanka Thakur
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Mukesh Sharma
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Treatment of patients with anaplastic thyroid cancer during the last 20 years: whether any progress has been made? Eur Arch Otorhinolaryngol 2014; 272:1553-67. [DOI: 10.1007/s00405-014-3108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022]
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Influence of risk grouping on therapeutic decisions in patients with anaplastic thyroid carcinoma. Eur Arch Otorhinolaryngol 2014; 272:985-993. [DOI: 10.1007/s00405-014-2937-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
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He X, Li D, Hu C, Wang Z, Ying H, Wu Y. Outcome after intensity modulated radiotherapy for anaplastic thyroid carcinoma. BMC Cancer 2014; 14:235. [PMID: 24690325 PMCID: PMC3976675 DOI: 10.1186/1471-2407-14-235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/25/2014] [Indexed: 01/29/2023] Open
Abstract
Background Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC. Methods 13 patients with ATC who were treated by IMRT in our institution between October 2008 and February 2011, have been analyzed. The target volume for IMRT was planned to include Gross tumor volume (GTV): primary tumor plus any N + disease (66 Gy/33 F/6.6 W), with elective irradiation of thyroid bed, bilateral level II through VI and mediastinal lymph nodes to the level of the carina (54-60 Gy). Seven patients received surgical intervention and eleven patients had chemotherapy. Results The median radiotherapy dose to GTV was 60 Gy/30 fractions/6 weeks. The median survival time of the 13 patients was 9 months. The direct causes of death were distant metastases (75%) and progression of the locoregional disease (25%). Ten patients were spared dyspnea and tracheostomy because their primary neck lesion did not progress. Conclusion The results showed that IMRT combined by surgery and chemotherapy for ATC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases.
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Affiliation(s)
| | | | | | | | | | - Yi Wu
- Department of Head and Neck Surgery, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Anaplastic thyroid cancer: the addition of systemic chemotherapy to radiotherapy led to an observed improvement in survival--a single centre experience and review of the literature. ScientificWorldJournal 2014; 2014:674583. [PMID: 25184150 PMCID: PMC3947878 DOI: 10.1155/2014/674583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/11/2013] [Indexed: 01/27/2023] Open
Abstract
Introduction. Anaplastic thyroid carcinoma (ATC) is rare yet accounts for up to 50% of all thyroid cancer deaths. This study reviews outcomes of patients with confirmed ATC referred to a tertiary oncology centre plus reviews the literature to explore how poor outcomes may be improved. Materials and Methods. The management and outcomes of 20 patients with ATC were reviewed. Results. Median age at diagnosis was 69.5 years. 19 patients died due to ATC, 40% of whom died from asphyxiation. Median survival for all cases was 59 days. Patients who had previous surgery prior to other treatment modalities had a longer median survival overall compared to those who had not had previous surgery (142 days compared to 59 days) and produced the one long-term survivor. Chemotherapy followed by radiotherapy (without previous surgery) was associated with longer median survival (220 days). Palliative radiotherapy alone did not decrease the rate of death by asphyxiation when compared to other single modality treatments. Conclusion. Multimodality treatment including surgery when feasible remains the best strategy to improve survival and prevent death from asphyxiation in the management of ATC. The addition of chemotherapy to our institutional protocol led to improved survival but prognosis remains very poor.
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Sun C, Li Q, Hu Z, He J, Li C, Li G, Tao X, Yang A. Treatment and prognosis of anaplastic thyroid carcinoma: experience from a single institution in China. PLoS One 2013; 8:e80011. [PMID: 24224029 PMCID: PMC3818277 DOI: 10.1371/journal.pone.0080011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background Anaplastic thyroid carcinoma (ATC), a highly aggressive malignancy, has a poor prognosis, and the consensus on the most effective treatment is needed. Methods Clinical data from all ATC patients treated in our institution over a 30-year period (between May 1980 and May 2010) were analyzed retrospectively with regard to mortality and survival rates (Kaplan–Meier). Multivariate analysis was performed using a Cox proportional hazards model. Results Sixty cases were analyzed. The overall 1- and 3-year survival rates were 35.0% and 22.9%, respectively. Univariate analysis showed that the best prognosis was seen in patients younger than 55 years, those without distant metastases, those with white blood cell (WBC) counts < 10.0 × 109/L or blood platelet (PLT) counts < 300.0 × 109/L at presentation, those who did not receive chemotherapy, and those who received radiotherapy doses ≥ 40 Gy or underwent surgery plus postoperative radiotherapy. According to multivariate analysis, the WBC count at first presentation and the type of therapeutic regimen independently influenced survival. Conclusions We found that the elevated peripheral PLT count may be an adverse prognostic factor of ATC patients. The prognosis for ATC is especially poor for patients with distant metastasis, a WBC count ≥ 10.0×109/L, a PLT count ≥ 300.0 × 109/L, or age ≥ 55 years. WBC count at presentation and surgery with or without postoperative radiotherapy independently influenced the prognosis. Intensive treatment combining surgery with postoperative radiotherapy is recommended for ATC patients with stage IVA/B disease.
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Affiliation(s)
- Chuanzheng Sun
- Department of Head and Neck Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Qiuli Li
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
| | - Zedong Hu
- Department of Head and Neck Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Jiehua He
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chao Li
- Department of Head and Neck Surgery, The Tumor Hospital of Sichuan Province, Chengdu, Sichuan, People’s Republic of China
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Xiaofeng Tao
- Radiology Department of Shanghai Ninth People’s Hospital Affiliated Shanghai JiaoTong University School of Medicine, Shanghai, People’s Republic of China
- * E-mail: cjr.taoxiaofeng.@vip.163.com (XFT); (AKY)
| | - Ankui Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
- * E-mail: cjr.taoxiaofeng.@vip.163.com (XFT); (AKY)
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Sun X, Sun S, Guevara N, Fakhry N, Marcy P, Lassalle S, Peyrottes I, Bensadoun R, Lacout A, Santini J, Cals L, Bosset J, Garden A, Thariat J. Chemoradiation in anaplastic thyroid carcinomas. Crit Rev Oncol Hematol 2013; 86:290-301. [DOI: 10.1016/j.critrevonc.2012.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 10/13/2012] [Accepted: 10/24/2012] [Indexed: 02/03/2023] Open
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[Radiation therapy in thyroid cancer]. Cancer Radiother 2013; 17:233-43; quiz 255-6, 258. [PMID: 23763764 DOI: 10.1016/j.canrad.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/24/2012] [Accepted: 12/06/2012] [Indexed: 12/15/2022]
Abstract
Anaplastic thyroid cancers represent 1-2% of all thyroid tumours and are of very poor prognosis even with multimodality treatment including external beam radiation therapy. Conversely, differentiated thyroid carcinomas (at least 80% of thyroid cancers) hamper good prognosis with surgery with or without radioiodine and there is hardly any room for external beam radiation therapy. Insular and medullar carcinomas have intermediary prognosis and are rarely irradiated. We aimed to update recommendations for external beam irradiation in these different clinical situations and put in light the benefits of new irradiations techniques. A search of the French and English literature was performed using the following keywords: thyroid carcinoma, anaplastic, chemoradiation, radiation therapy, surgery, histology and prognostic. Non-mutilating surgery (often limited to debulking) followed by systematic external beam radiation therapy is the standard of care in anaplastic thyroid cancers (hyperfractionated-accelerated radiation therapy with low-dose weekly doxorubicin with or without cisplatin if possible). Given anaplastic thyroid cancers' median survival of 10 months or less, neoadjuvant and adjuvant chemotherapy may also be discussed. Ten-year survival rates for patients with papillary, follicular and Hürthle-cell carcinomas are 93%, 85%, and 76%, respectively. Massive primary incompletely resected iodine-negative disease indicates external beam radiation therapy. Older age (45 or 60-year-old), poor-prognosis histological variants (including tall cell cancers) and insular cancers are increasingly reported as criteria for external beam radiation therapy. Massive extracapsular incompletely resected nodal medullary disease suggests external beam radiation therapy. Radiation therapy morbidity has been an important limitation. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumour coverage and organ sparing, reducing late toxicities to less than 5%. The role of radiation therapy is evolving for anaplastic thyroid cancers using multimodal strategies and new chemotherapy molecules, and for differentiated cancers using minor criteria, such as histological variants, with IMRT becoming a standard of care.
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Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, Kebebew E, Lee NY, Nikiforov YE, Rosenthal MS, Shah MH, Shaha AR, Tuttle RM. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 2012; 22:1104-39. [PMID: 23130564 DOI: 10.1089/thy.2012.0302] [Citation(s) in RCA: 477] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC. METHODS Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop. RESULTS The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations. CONCLUSIONS These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.
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Oh EM, Lee KE, Kwon H, Kim EY, Bae DS, Youn YK. Analysis of patients with anaplastic thyroid cancer expected to have curative surgery. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:123-9. [PMID: 22977757 PMCID: PMC3433547 DOI: 10.4174/jkss.2012.83.3.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/15/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Abstract
Purpose Anaplastic thyroid cancer (ATC) is rare and has a poor prognosis. The aim of this study was to analyze the clinicopathologic characteristics of patients diagnosed with ATC expected to undergo curative thyroidectomy, with the goal of finding differences between patients surviving ≥6 months and <6 months. Methods From 1981 to 2010, 24 patients underwent thyroidectomy due to ATC. Among those patients, 12 suspected of distant metastasis preoperatively were excluded. The remaining 12 patients were analyzed by retrospective review of electronic medical records. Results Median age was 55 years, and the male to female ratio was 1:5. All patients presented with neck mass at initial diagnosis. Five patients lived <6 months and seven patients lived ≥6 months after operation. In patients surviving ≥6 months, all lesions were <5 cm and all patients underwent total thyroidectomy. In patients surviving <6 months, two of the four lesions were >5 cm, and two of the five patients underwent less than total thyroidectomy (P = 0.287 and 0.152, respectively). All patients with lesion size <5 cm underwent total thyroidectomy and showed a shorter median operation time (P = 0.182 and 0.033, respectively). Conclusion ATC showed female predominance. Patients initially presented with neck mass, and median age was 55 years. In patients with ATC who are expected to undergo curative thyroidectomy, surgery should actively be considered as primary therapy for patient survival when the size is <5 cm.
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Affiliation(s)
- Eun Mee Oh
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Concurrent doxorubicin and radiotherapy for anaplastic thyroid cancer: A critical re-evaluation including uniform pathologic review. Radiother Oncol 2011; 101:425-30. [DOI: 10.1016/j.radonc.2011.09.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/17/2011] [Accepted: 09/05/2011] [Indexed: 11/21/2022]
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Ito KI, Hanamura T, Murayama K, Okada T, Watanabe T, Harada M, Ito T, Koyama H, Kanai T, Maeno K, Mochizuki Y, Amano J. Multimodality therapeutic outcomes In anaplastic thyroid carcinoma: Improved survival in subgroups of patients with localized primary tumors. Head Neck 2011; 34:230-7. [DOI: 10.1002/hed.21721] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 10/31/2010] [Accepted: 12/13/2010] [Indexed: 11/06/2022] Open
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Poisson T, Deandreis D, Leboulleux S, Bidault F, Bonniaud G, Baillot S, Aupérin A, Al Ghuzlan A, Travagli JP, Lumbroso J, Baudin E, Schlumberger M. 18F-fluorodeoxyglucose positron emission tomography and computed tomography in anaplastic thyroid cancer. Eur J Nucl Med Mol Imaging 2010; 37:2277-85. [DOI: 10.1007/s00259-010-1570-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
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Smallridge RC, Copland JA. Anaplastic thyroid carcinoma: pathogenesis and emerging therapies. Clin Oncol (R Coll Radiol) 2010; 22:486-97. [PMID: 20418080 PMCID: PMC3905320 DOI: 10.1016/j.clon.2010.03.013] [Citation(s) in RCA: 295] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/04/2010] [Accepted: 03/23/2010] [Indexed: 01/12/2023]
Abstract
Anaplastic thyroid carcinoma ranges from 1.3 to 9.8% of all thyroid cancers globally. Mutations, amplifications, activation of oncogenes and silencing of tumour suppressor genes contribute to its aggressive behaviour, and recent studies (e.g. microarrays, microRNAs) have provided further insights into its complex molecular dysregulation. Preclinical studies have identified numerous proteins over- or underexpressed that affect critical cellular processes, including transcription, signalling, mitosis, proliferation, cell cycle, apoptosis and adhesion, and a variety of agents that effectively inhibit these processes and tumour growth. In clinical studies of 1771 patients, 64% were women, the median survival was 5 months, and 1-year survival was 20%. The variables associated with survival in some series included age, tumour size, extent of surgery, higher dose radiotherapy, absence of distant metastases at presentation, co-existence of differentiated thyroid cancer and multimodality therapy. However, considerable bias exists in these non-randomised studies. Although more aggressive radiotherapy has reduced locoregional recurrences, the median overall survival has not improved in over 50 years. Newer systemic therapies are being tried, and more effective combinations are needed to improve patient outcomes.
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Affiliation(s)
- R C Smallridge
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Abstract
This article discusses the role of external beam radiotherapy (XRT) in the management of well-differentiated thyroid cancer (WDTC), medullary thyroid cancer, and anaplastic thyroid cancer. Although there are no randomized controlled studies on the use of XRT in thyroid cancer, evidence supports its use to treat gross disease after surgery or unresectable cancer and its use as an adjuvant after resection of a known high-risk disease in WDTC, and, to a lesser extent, in medullary thyroid cancer. The use of XRT for the palliation of symptomatic disease and recent advances in the technology of radiation delivery also will be discussed.
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Affiliation(s)
- James D Brierley
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, ON, Canada.
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Pudney D, Lau H, Ruether JD, Falck V. Clinical experience of the multimodality management of anaplastic thyroid cancer and literature review. Thyroid 2007; 17:1243-50. [PMID: 18177257 DOI: 10.1089/thy.2007.0026] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Anaplastic Thyroid Carcinoma (ATC) is a rare thyroid tumor with a very aggressive clinical course. The following is a report of five patients with inoperable locally advanced disease treated at our institution using multimodality management consisting of chemotherapy and hyperfractionated accelerated radiotherapy. A flow diagram with management recommendations for inoperable ATC is suggested.
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Affiliation(s)
- Delia Pudney
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Canada
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Abstract
Undifferentiated or anaplastic carcinoma is an uncommon histologic type of thyroid cancer. It is one of the most aggressive malignancies associated with a poor prognosis. Most patients are elderly presenting as locally advanced disease with nodal and distant metastases. Complete surgical resection is frequently not possible and there is no effective systemic therapy. Aggressive multimodal therapy including surgery, radiation, and chemotherapy is recommended for management. However, because of the rarity of the disease, its aggressiveness and the lack of prospective treatment protocols, nearly all evidence in the literature comes from retrospective case series or cohort studies for selected patients' subgroups treated over a relatively long study period. Evidence of therapeutic benefit of one treatment option over another is lacking. Prognosis remains dismal with a median survival of 2-12 months Surgery remains an important component of the multimodal therapy and is commonly adopted as primary treatment. Although radical resection should be discouraged, resection without inducing significant morbidity can be considered for good risk patients with resectable tumors. It provides an effective form of palliation with potential cure when combined with postoperative radiotherapy and/or chemotherapy. Patients selected for surgical resection was frequently identified to have improved survival. A regime of preoperative hyperfractionated radiotherapy and doxorubicin followed by surgery when feasible has been documented to achieve local control and avoid tracheostomy for ATC patients. Because of the ineffectiveness of all conventional treatment modalities, novel molecular targeted therapies are being developed to tackling this uniformly fatal disease with promising results.
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Affiliation(s)
- Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China
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Kim TY, Kim KW, Jung TS, Kim JM, Kim SW, Chung KW, Kim EY, Gong G, Oh YL, Cho SY, Yi KH, Kim WB, Park DJ, Chung JH, Cho BY, Shong YK. Prognostic factors for Korean patients with anaplastic thyroid carcinoma. Head Neck 2007; 29:765-72. [PMID: 17274052 DOI: 10.1002/hed.20578] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC), although rare, is one of the most aggressive human cancers, and patients with ATC have extremely poor prognoses despite various therapeutic measures. We wished to determine the prognostic factors of survival and effect of treatment on survival rate in patients with ATC. METHODS We retrospectively reviewed the medical records of the 121 patients (41 men and 80 women) diagnosed with ATC from January 1995 to June 2004 at 5 major referral centers in Korea. RESULTS Mean patient age at diagnosis was 64 +/- 11 years (range, 17-84 years). Of the 121 patients, 11 (9%) had intrathyroidal tumors, 69 (57%) had extrathyroidal tumors or lymph node involvement, 29 (24%) had distant metastases, and 12 had no data about staging (9%). The mean tumor diameter was 5.5 +/- 2.5 cm (range, 0.5-17.0 cm). At a median follow-up of 41 months (range, 26-122 months), 8 patients were alive. Median survival time was 5.1 months. The disease-specific survival rates were 42% at 6 months, 16% at 12 months, and 9% at 24 months. Sixteen patients (13%) received only supportive care, 25 (21%) received surgery alone, 20 (16%) received radiation treatment or chemotherapy without surgery, and 60 (50%) received surgery plus radiation treatment or chemotherapy. Multivariate analysis showed 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. CONCLUSIONS Long-term survival is possible for ATC patients less than 60 years old and with small localized tumors. Although aggressive multimodal therapy, including surgery, radiation treatment, and chemotherapy, was not significantly associated with improved survival, we advocate aggressive multimodal therapy in selected ATC patients with good prognostic factors.
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Affiliation(s)
- Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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