A multimodality therapeutic approach in anaplastic thyroid carcinoma: Study on 39 patients

The aim of this study was to investigate the role of multimodality treatmen t in patients with anaplastic thyroid carcinoma. from 1992 to 1999, 39 cons ecutive patients with a histologically or cytologically proven anaplastic t hyroid carcinoma were referred to the Thyroid Center of Padua General Hospi tal. There were 28 females and 11 males with a median age of 69 years (rang e 39-88 years). About one-third of patients had a history of preceeding nod ular goiter. Two patients had areas of differentiated thyroid carcinoma at histological examination. Local disease was present in 26 patients while di stant metastases, mainly to the lung, were present in 22 at diagnosis or qu ickly developed during the observation period in all the others except one. Thirty-two patients were previously untreated: 9 of them were in good gene ral condition, 1 had limited lung metastases, and the tumor mass was consid ered resectable by the surgeon. These 9 patients were treated with cisplati n once a week and radiotherapy (RT) 36Gy in 18 fractions over three weeks, followed by total thyroidectomy (TT) and by further chemotherapy (CHT) with adriamycin and bleomycin in 4 patients. Seven patients, 3 with lung metast ases at diagnosis, had undergone TT, followed by RT in 5, in another hospit al and were subsequently referred to our center due to the presence of dist ant metastases. Therefore, a total of 16 patients (Group 1)was treated with TT, RT and CHT in various order. Nine patients with distant metastases at diagnosis (Group 2) received CHT; one of them had a disappearance of lung m etastases and was then treated by TT and further CHT. Group 3 consisted of 14 elderly patients in poor general conditions; 4 of these received local R T, while the remaining did not receive any treatment. Four complete respons es were seen in patients from Group 1, and 1 from Group 2. One patient with out distant metastases at diagnosis is alive and free of disease 6 months a fter TT and adjuvant CHT, and 12 months after diagnosis. Three had long-ter m survival (14, 24, 27 months) with a disease-free interval of 6-8-10 month s. The patient from Group 2 who was treated in a second time by TT is alive without disease after 60 months. Median survival rate was 11 months for Gr oup 1, 5.7 months for Group 2 and 4 months for Group 3. In some patients mu ltimodality treatment (TT, RT and CHT) is associated with increased surviva l. Nine out of 16 patients, who underwent surgery and complementary treatme nt, had no local progression. In all but one distant metastases developed, mainly in the lung, during or after post-surgical CHT. The best results wer e obtained in younger patients with less advanced disease. Early diagnosis is mandatory. Only a few patients responded to CHT, confirming that anaplas tic thyroid carcinoma is often resistant to anticancer drugs. Our experienc e with combination modalities suggests that aggressive and appropriate comb inations of RT, TT and CHT may provide some benefit in patients with anapla stic thyroid carcinoma. Preoperative CHT and RT may enhance surgical resect ability of the primary tumor. (C) 2000, Editrice Kurtis.