Extended surgery and early postoperative radiotherapy for undifferentiatedthyroid carcinoma

The current study was devised to evaluate the therapeutic potential of exte nded surgery for improving survival in undifferentiated thyroid carcinoma ( UTC). An institutional retrospective survival analysis (July 1994 to Decemb er 1998) of 30 patients who underwent surgery for UTC with locally curative intent was done. Median anti 1-year survival was 4 months and 37%, respect ively. Primary patients were older (70 vs. 59 years; p = 0.026) and decease d earlier (median survival 4 vs. 20 months; p = 0.027, log-rank test) than their reoperative counterparts, suggesting a referral bias toward younger p atients. Survival analysis was restricted to primary pT4 UTC, leaving 18 pa tients. On univariate analysis, pN and M category, degree of resection (R2 versus R0/1 and radiotherapy (0-30 Gy versus > 30 Gy) were identified as pa rameters suitable for further testing. On multivariate analysis, pN1 was a significant prognosticator of decreased survival (RR = 5.9; p = 0.043), fol lowed by R2 (RR = 4.1, p = 0.088) and MZ (RR = 3.6; p = 0.089). Because of low patient numbers after stratification for radiotherapy, only pN and degr ee of resection were analyzed on subsequent multivariate analysis. Ln the i ncomplete radiotherapy stratum, neither of the two parameters affected surv ival, whereas R2 and pN1 limited survival in the complete radiotherapy stra tum. In primary pT4 UTC, a subset of pNO patients with R0/1 resections and radiotherapy greater than 30 Gy seemed to benefit from extended surgery. Be cause pN1 and R2 patients with radiotherapy of 30 Gy or less comprised most UTC patients, only 1-year, but not median, survival improved compared to l iterature controls.