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Buzzoni R, Catena L, Cortinovis D, Dognini G, Bajetta E. Integrated Therapeutic Strategies for Anaplastic Thyroid Carcinoma. TUMORI JOURNAL 2018; 89:544-6. [PMID: 14870782 DOI: 10.1177/030089160308900518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anaplastic thyroid carcinoma (ATC) is a very rare neoplasm with an aggressive course. The prognosis has not changed in the last decades and the median survival does not exceed six months. Only few patients with incidental limited ATC will be cured. Different therapeutic options have been explored but the results are disappointing. At present, new drugs and new timing for proper treatment are under investigation. In this short review we have summarized these recent developments.
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Affiliation(s)
- Roberto Buzzoni
- UO Oncologia Medica B, National Cancer Institute, Milan, Italy
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Nayir E, Cor S, Altintas ZM, Buyukafsar K, Tiftik RN, Ata A, Arican A. Comparative investigation of antitumoral effectiveness of Rho-kinase inhibitor Y-27632, pravastatin and atorvastatin in anaplastic thyroid cancer cell culture. JOURNAL OF ONCOLOGICAL SCIENCES 2017. [DOI: 10.1016/j.jons.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Liu TR, Xiao ZW, Xu HN, Long Z, Wei FQ, Zhuang SM, Sun XM, Xie LE, Mu JS, Yang AK, Zhang GP, Fan Y. Treatment and Prognosis of Anaplastic Thyroid Carcinoma: A Clinical Study of 50 Cases. PLoS One 2016; 11:e0164840. [PMID: 27760217 PMCID: PMC5070824 DOI: 10.1371/journal.pone.0164840] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although anaplastic thyroid carcinoma (ATC) is rare, it is one of the most aggressive human cancers. The optimal multimodal therapy policy of ATC is still debated, and a standardized treatment strategy remains to be established. This study aimed to evaluate the management aspect and prognosis of ATC. MATERIALS AND METHODS The data were analyzed retrospectively for 50 patients with ATC to evaluate the clinical characters, management and factors influencing survival. Survival analysis was performed by Kaplan-Merier method and log-rank test, and multivariate analysis was performed using Cox proportional hazard model. RESULTS The 1-year and 2-year overall survival rates (OS) were 48.0% and 26.0% respectively in all patients, with the 2-year OS of 40.0% and 31.0% and 6.3% for stage IVA, IVB and IVC respectively (P <0.05). In stage IVA and IVB patients, combined surgery with radiotherapy improved overall survival, and the 2-year OS were 50.0% and 35.7% respectively in the group with combined surgery with radiotherapy and the group with surgery with only (P <0.05). Postoperative radiotherapy improved local control rate in stage IVA and IVB patients (P <0.05). However, surgery, radiotherapy or chemotherapy could not improve the survival of stage IVC patients. Multivariate analysis showed that distant metastases, surgery, radiotherapy and tumor residue could predict the prognosis. CONCLUSION Combined surgery and radiotherapy could improve overall survival in stage IVA and IVB patients. Patients with ATC have a bad prognosis. Distant metastases, surgery, radiotherapy and tumor residue are the most important factors affecting the prognosis.
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Affiliation(s)
- Tian-Run Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Wen Xiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Neng Xu
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States of America
| | - Zhen Long
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fan-Qin Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shi-Min Zhuang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Mei Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang-En Xie
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Sheng Mu
- Department of General Surgery, Xinhua Hospital, affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Biliary Tract Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - An-Kui Yang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- * E-mail: (AKY); (GPZ); (YF)
| | - Guan-Ping Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (AKY); (GPZ); (YF)
| | - Yi Fan
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States of America
- * E-mail: (AKY); (GPZ); (YF)
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Jiménez-Fonseca P, Gómez Saez JM, Santamaria Sandi J, Capdevila J, Navarro Gonzalez E, Zafon Llopis C, Ramón Y Cajal Asensio T, Riesco-Eizaguirre G, Grande E, Galofré JC. Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma. Clin Transl Oncol 2016; 19:12-20. [PMID: 27048161 DOI: 10.1007/s12094-016-1506-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 03/24/2016] [Indexed: 12/19/2022]
Abstract
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years.
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Affiliation(s)
- P Jiménez-Fonseca
- Medical Oncology Service, Hospital Universitario Central de Asturias, Avenida de Roma sn, 33011, Oviedo, Spain.
| | - J M Gómez Saez
- CIBERDEM, Endocrinology and Nutrition Service, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - J Santamaria Sandi
- Endocrinology and Nutrition Service, Hospital Universitario de Cruces, Vizcaya, Spain
| | - J Capdevila
- Medical Oncology Service, Hospital Universitario de la Vall d'Hebron, Barcelona, Spain
| | - E Navarro Gonzalez
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - C Zafon Llopis
- Endocrinology and Nutrition Service, Hospital Universitario de la Vall d'Hebron, Barcelona, Spain
| | | | - G Riesco-Eizaguirre
- Endocrinology and Nutrition Service, Hospital Universitario de Móstoles, Madrid, Spain
| | - E Grande
- Medical Oncology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J C Galofré
- Endocrinology and Nutrition Service, Clínica Universidad de Navarra, Pamplona, Spain
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Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma. ACTA ACUST UNITED AC 2015; 62:e15-22. [PMID: 25583658 DOI: 10.1016/j.endonu.2014.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/27/2014] [Indexed: 01/01/2023]
Abstract
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean overall survival has not improved in the past 50 years.
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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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ACR Appropriateness Criteria® thyroid carcinoma. Oral Oncol 2014; 50:577-86. [DOI: 10.1016/j.oraloncology.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/24/2022]
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8
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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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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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Suh HJ, Moon HJ, Kwak JY, Choi JS, Kim EK. Anaplastic thyroid cancer: ultrasonographic findings and the role of ultrasonography-guided fine needle aspiration biopsy. Yonsei Med J 2013; 54:1400-6. [PMID: 24142644 PMCID: PMC3809886 DOI: 10.3349/ymj.2013.54.6.1400] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To investigate the ultrasonographic (US) features of anaplastic thyroid cancer (ATC) and the diagnostic performance of US-guided fine needle aspiration biopsy (FNAB) therein. MATERIALS AND METHODS Eighteen cases of ATC diagnosed between January 2001 and May 2011 were included. FNAB was performed in all cases. Initial FNAB results were divided into three groups: 1) the cytological ATC group, cytological diagnosis of ATC; 2) the underestimated group, cytological diagnoses of malignancy other than ATC; and 3) the false negative group, cytological diagnoses of atypical, benign and non-diagnostic lesions. We retrospectively reviewed US findings and compared treatment modalities between each group. RESULTS Among the 18 patients, there were nine in the initially cytological ATC group, four in the underestimated group and five in the false negative group. The most common US features of ATC were a solid (64.7%) and irregular shaped (88.2%) mass with lymph node involvement (76.4%). However, except for lymph node involvement (p=0.003), US findings for each group were not statistically different. The initial cytological diagnostic accuracy of ATC was 50% (9/18). Surgery was performed less in the ATC group (11%) and the false negative group (20%) than the underestimated group (75%). CONCLUSION The US features of ATC were not especially different from other types of aggressive thyroid cancer. A correct diagnosis of ATC by initial US-FNAB was made in 50% of the patients, which is significant in that therapeutic surgery can be undertaken in lower numbers if correctly diagnosed.
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Affiliation(s)
- Hee Jung Suh
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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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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Prognostic factors and treatment outcomes for anaplastic thyroid carcinoma: ATC Research Consortium of Japan cohort study of 677 patients. World J Surg 2012; 36:1247-54. [PMID: 22311136 DOI: 10.1007/s00268-012-1437-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To date, most findings about ATC have been derived from single-institution studies with limited numbers of cohorts. To obtain further insights into this "orphan disease," we have established a multicenter registry, the ATC Research Consortium of Japan (ATCCJ). We analyzed prognostic factors and treatment outcomes using the large cohort database of the ATCCJ. METHODS Most of the Japanese centers involved in the treatment of thyroid cancer were invited to join the ATCCJ and have provided information on ATC patients treated between 1995 and 2008. The database includes 677 cases from 38 registered institutions. Survival curves were determined using Kaplan-Meier methods and were compared using the log-rank test. Cox's proportional hazards model was used for multivariate analysis. RESULTS Clinical varieties of ATC were classified into four types: common type (n = 547); incidental type (n = 29); anaplastic transformation at the neck (n = 95); anaplastic transformation at a distant site (n = 6). The incidental type followed by anaplastic transformation at the neck showed better outcomes than the other types. Anaplastic transformation at a distant site showed the worst outcomes. The 6-month and 1-year cause-specific survival (CSS) rates for common-type ATC were 36 and 18%, respectively. In all, 84 (15%) achieved long-term (>1 year) survival. Multivariate analysis identified age ≥70 years, presence of acute symptoms, leukocytosis (white blood cell count ≥10,000/mm(3)), large tumor >5 cm, T4b tumor, and distant metastasis as significant risk factors for lower survival. CSS rates also differed significantly depending on UICC stages, with 6-month CSSs of 60% for stage IVA, 45% for IVB, and 19% for IVC. For 36 of 69 (52%) stage IVA patients who underwent radical surgery, adjuvant therapies, including radiation therapy (RTX) and chemotherapy (CTX) did not show additional benefit statistically. Conversely, among 242 stage IVB patients, 80 (33%) underwent radical surgery. For those patients, therapies combining RTX with CTX significantly improved CSS. CONCLUSIONS Long-term survival is possible for selected patients with ATC. To determine the treatment strategy, UICC stage (disease extent) and other prognostic factors (e.g., biologic malignancy grade) should be considered.
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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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Sung TY, Choi SH, Lee JM, Jeong JJ, Kang SW, Chung WY. Innovative in vitro chemo-hormonal drug therapy for refractory thyroid carcinomas. J Korean Med Sci 2012; 27:729-35. [PMID: 22787366 PMCID: PMC3390719 DOI: 10.3346/jkms.2012.27.7.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/19/2012] [Indexed: 11/20/2022] Open
Abstract
More than 95% of the thyroid carcinomas are well differentiated types showing favorable prognosis. However, only a few therapeutic options are available to treat the patients with undifferentiated thyroid carcinomas, especially with refractory thyroid carcinomas that are not amenable to surgery or radioiodine ablation. We investigated the anticancer effects of 20 chemotherapy and hormonal therapy drugs on 8 thyroid carcinoma cell lines. In vitro chemosensitivity was tested using the adenosine-triphosphate-based chemotherapy response assay (ATP-CRA). The tumor inhibition rate (TIR; or cell death rate) or half maximal inhibitory concentration (IC(50)) was analyzed to interpret the results. Of the 12 chemotherapy drugs, etoposide (178.9 index value in follicular carcinoma cell line) and vincristine (211.7 in Hürthle cell carcinoma cell line) were the most active drugs showing the highest chemosensitivity, and of the 8 additional drugs, trichostatin A (0.03 µg/mL IC(50) in follicular carcinoma cell line) showed favorable outcome having the anticancer effect. In our study, the result of etoposide and vincristine show evidence as active anticancer drugs in thyroid carcinoma cell lines and trichostatin A seems be the next promising drug. These drugs may become an innovative therapy for refractory thyroid carcinomas in near future.
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Affiliation(s)
- Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment. JOURNAL OF ONCOLOGY 2011; 2011:542358. [PMID: 21772843 PMCID: PMC3136148 DOI: 10.1155/2011/542358] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/03/2011] [Indexed: 01/29/2023]
Abstract
Anaplastic thyroid cancer (ATC) is an uncommon malignancy of the thyroid. Only 1-2% of thyroid cancers are anaplastic, but the disease contributes to 14–50% of the mortality with a median survival of 3 to 5 months. Most patients diagnosed with this disease are 65 years of age or older. The incidence of anaplastic thyroid cancer is decreasing worldwide. Most patients present with a rapidly growing neck mass, dysphagia, or voice change. We performed a comprehensive literature search using PubMed focusing on the treatment of anaplastic thyroid cancer including historical review of treatment and outcomes and investigations of new agents and approaches. A total of sixteen chart review and retrospective studies and eleven prospective studies and/or clinical trials were reviewed. The current standard therapeutic approach is to consider the disease as systemic at time of diagnosis and pursue combined modality therapy incorporating cytoreductive surgical resection where feasible and/or chemoradiation either concurrently or sequentially. Doxorubicin is the most commonly used agent, with a response rate of 22%. Several new agents are currently under investigation. Referral of patients for participation in clinical trials is needed.
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Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.3342/kjorl-hns.2011.54.1.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Surgery and Radiotherapy Improves Survival in Patients With Anaplastic Thyroid Carcinoma. Am J Clin Oncol 2008; 31:460-4. [DOI: 10.1097/coc.0b013e31816a61f3] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Anaplastic thyroid cancer is an uncommon, typically lethal malignancy of older adults with no effective systemic therapy. The mean survival time is usually less than 6 months from the time of diagnosis and, unfortunately, this outcome is not fundamentally altered by available treatments. Histologic tissue confirmation is recommended if the diagnosis is not absolutely certain to exclude tumors with better prognosis or that require different treatment. Patency of the airway should be kept in mind throughout the patient's course and individuals with impending airway obstruction, in the absence of imminent death from other sites of disease, should be considered for a tracheostomy to secure the airway. Enrollment in meaningful clinical trials should be given the highest priority at all decision points.
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Affiliation(s)
- Ryan L Neff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, The Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, OH 43210-1228, USA
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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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Kim WB, Kim TY, Kwon HS, Moon WJ, Lee JB, Choi YS, Kim SK, Kim SW, Chung KW, Baek JH, Kim BI, Park DJ, Na DG, Choe JH, Chung JH, Jung HS, Kim JH, Nam KH, Chang HS, Chung WY, Hong SW, Hong SJ, Lee JH, Yi KH, Jo YS, Kang HC, Shong M, Park JW, Yoon JH, Kang SJ, Lee KW. Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.3803/jkes.2007.22.3.157] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Hyuk Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine, Korea
| | - Jae Bok Lee
- Department of Surgery, Korea University College of Medicine, Korea
| | - Young Sik Choi
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | | | | | | | - Jung Hwan Baek
- Department of Radiology, Daerim St. Mary's Hospital, Korea
| | | | - Do Joon Park
- Department of Internal Medicine, Seoul National University School of Medicine, Korea
| | - Dong Gyu Na
- Department of Radiology, Seoul National University School of Medicine, Korea
| | - Jun Ho Choe
- Department of Surgery, Seoul National University School of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Hye Seung Jung
- Department of Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Jeong Han Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Korea
| | - Kee Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Hang-Seok Chang
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Soon Won Hong
- Department of Pathology, Yonsei University College of Medicine, Korea
| | - Suck Joon Hong
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Jeong Hyun Lee
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea
| | - Young Suk Jo
- Department of Internal Medicine, School of Medicine, Eulji University, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Minho Shong
- Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, Chungbuk National University College of Medicine, Korea
| | - Jong Ho Yoon
- Department of Surgery, Hallym University College of Medicine, Korea
| | - Seong Joon Kang
- Department of Surgery, Yonsei University Wonju College of Medicine, Korea
| | - Kwang Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
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Miccoli P, Materazzi G, Antonelli A, Panicucci E, Frustaci G, Berti P. New trends in the treatment of undifferentiated carcinomas of the thyroid. Langenbecks Arch Surg 2006; 392:397-404. [PMID: 17131154 DOI: 10.1007/s00423-006-0115-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Malignant tumours of the thyroid are generally classified as either well-differentiated thyroid carcinoma, which is composed of papillary and follicular carcinoma, or undifferentiated/anaplastic thyroid carcinoma (ATC). ATC is not only the most lethal disease in the field of endocrine surgery but also one of the most aggressive tumours characterized by an almost invariable fatal outcome, which only very rarely exceeds a 1-year course. DISCUSSION The impact of surgical resection in association with external beam radiation on ATC outcome has been extensively investigated also in studies based on multicentric database, and there is a general agreement on the significance of a complete resection of the tumour. It has been difficult up to now to collect data regarding chemotherapy adjuvant treatment. In spite of the lack of an extensive review about the results of this kind of treatment by itself or as part of a multimodal approach, it seems that among the several chemotherapy agents experienced, none proved to influence significantly ATC prognosis. Neither doxorubicin (the most commonly used) nor other drugs, such as cisplatin, bleomycin, fluorouracil or cyclophosphamide, showed any real efficacy in controlling the disease. CONCLUSION The most recent development in this field seems to be represented by the possibility offered by PPARg agonists; even more promising might be the use of adenovirus-mediated p53 tumour suppressor gene therapy or BMP-7. All these new therapies need further confirmation coming from ongoing clinical trials such as those involving the use of vascular and growth factor-targeted agents.
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Affiliation(s)
- Paolo Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
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Podtcheko A, Ohtsuru A, Namba H, Saenko V, Starenki D, Palona I, Sedliarou I, Rogounovitch T, Yamashita S. Inhibition of ABL tyrosine kinase potentiates radiation-induced terminal growth arrest in anaplastic thyroid cancer cells. Radiat Res 2006; 165:35-42. [PMID: 16392960 DOI: 10.1667/rr3466.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gleevec, a selective tyrosine kinase inhibitor, retarded the growth of anaplastic thyroid cancer cell lines in vitro and in vivo through selective inhibition of ABL tyrosine kinase activity. In the present study, we investigated the ability of Gleevec to modulate the in vitro and in vivo radiation response of anaplastic thyroid cancer cells. Cell growth assays, colony formation assays and xenograft models were used to quantify the radiosensitizing effect of Gleevec in cells of the anaplastic thyroid cancer cell lines ARO and FRO. FACS, Western blotting and histochemical techniques were employed to study the mechanisms of radiation response after exposure to Gleevec. Gleevec (7.0 microM) increased the anti-proliferative effect of radiation on the growth ARO and FRO cells in vitro. Clonogenic analysis demonstrated that Gleevec reduced cell survival after irradiation. Gleevec combined with radiation produced an increase in tumor growth inhibition compared to treatment with either modality alone in mice bearing anaplastic thyroid cancer xenografts. The drug suppressed radiation-induced ABL activation and promoted CDKN1A (p21(cip1)) accumulation in irradiated anaplastic thyroid cancer cells. Gleevec had an additional effect on radiation-induced apoptosis in cells of both cell lines and potentiated the induction of terminal growth arrest accompanied by the expression of senescence-associated beta-galactosidase. The antitumor effect of Gleevec is potentiated in adjunctive therapy with radiation not only due to inhibition of proliferative cell growth with transient cell cycle arrest and apoptosis, but also due to the terminal growth arrest associated with senescence, suggesting that tumor cell senescence is a mechanism for tumor targeting therapy in combination with ionizing radiation.
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Affiliation(s)
- A Podtcheko
- Department of Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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25
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Bulgin D, Podtcheko A, Takakura S, Mitsutake N, Namba H, Saenko V, Ohtsuru A, Rogounovitch T, Palona I, Yamashita S. Selective pharmacologic inhibition of c-Jun NH2-terminal kinase radiosensitizes thyroid anaplastic cancer cell lines via induction of terminal growth arrest. Thyroid 2006; 16:217-24. [PMID: 16571083 DOI: 10.1089/thy.2006.16.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT The high radioresistance of anaplastic thyroid cancer (ATC) and cultured ATC cells stipulates for the means of increasing their radiosensitivity. It has been shown that c-Jun NH(2)-terminal kinase (JNK) activation is one of the manifestations of radiation response in ATC cells. OBJECTIVE Assessment of the effect of selective JNK inhibition on ATC cell radiosensitivity and clarification of the associated mechanisms. RESULTS The JNK inhibitor markedly suppressed ATC cell growth in a reversible cytostatic manner. The combination treatment with JNK inhibitor plus ionizing radiation induced a significant decrease in clonogenic survival of irradiated cells as compared with either singular treatment. The effect was not due to apoptosis of exposed cells but to a profound senescence-like terminal growth arrest occurring irrespectively of cells' p53 mutational status. Postradiational DNA damage repair was also significantly compromised in the presence of SP600125. CONCLUSIONS JNK signaling is an essential component of ATC cell proliferation and survival after radiation therapy. Hence, pharmacological interference with JNK pathway in combination with radiotherapy may be a promising treatment of ATC.
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Affiliation(s)
- Dmitry Bulgin
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Veness MJ, Porter GS, Morgan GJ. Anaplastic thyroid carcinoma: dismal outcome despite current treatment approach. ANZ J Surg 2004; 74:559-62. [PMID: 15230790 DOI: 10.1111/j.1445-2197.2004.03062.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC) accounts for <5% of all thyroid malignancies and is one of the most aggressive malignancies known. Survival is limited to months and death is often caused by uncontrolled neck disease. There is evidence that multimodality treatment, incorporating surgery (Sx), external beam radiotherapy (RT) and chemotherapy (CT), might enhance local control and improve survival. METHODS Between 1979 and 2002, 18 patients with ATC were referred to the multidisciplinary Head and Neck Cancer Service, Westmead Hospital, Sydney, Australia. The aim of the present study is to report on the treatment and outcome of these patients. Survival was calculated from the time of diagnosis until death using the Kaplan-Meier method. RESULTS Median age at diagnosis was 72 years (29-92 years) in 12 women and six men. Five patients had distant metastases at diagnosis. Seven patients were treated with various combinations of Sx, RT and/or CT. Ten patients received a single modality, including three undergoing a total thyroidectomy. Many patients died from local disease progression. Only one patient received triple modality treatment (Sx/RT/CT), surviving 26 months, and maintaining local control until death. Sixteen patients died from disease with a median survival of 6.2 months (0.3-56.8 months). CONCLUSION Most patients with ATC are incurable; however, a multimodality approach incorporating Sx and RT +/- CT, in selected individuals, might improve local control and extend survival.
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Affiliation(s)
- Michael J Veness
- Head and Neck Cancer Service, Westmead Hospital, Sydney, New South Wales, Australia.
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