De Crevoisier Renaud, Baudin Eric, Bachelot Anne, Leboulleux Sophie, Travagli Jean-Paul, Caillou Bernard, Schlumberger Martin
Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1137-43. doi: 10.1016/j.ijrobp.2004.05.032.
To analyze a prospective protocol combining surgery, chemotherapy (CT), and hyperfractionated accelerated radiotherapy (RT) in anaplastic thyroid carcinoma.
Thirty anaplastic thyroid carcinoma patients (mean age, 59 years) were treated during 1990-2000. Tumor extended beyond the capsule gland in 26 patients, with tracheal extension in 8. Lymph node metastases were present in 18 patients and lung metastases in 6. Surgery was performed before RT-CT in 20 patients and afterwards in 4. Two cycles of doxorubicin (60 mg/m(2)) and cisplatin (120 mg/m(2)) were delivered before RT and four cycles after RT. RT consisted of two daily fractions of 1.25 Gy, 5 days per week to a total dose of 40 Gy to the cervical lymph node areas and the superior mediastinum.
Acute toxicity (World Health Organization criteria) was Grade 3 or 4 pharyngoesophagitis in 10 patients; Grade 4 neutropenia in 21, with infection in 13; and Grade 3 or 4 anemia and thrombopenia in 8 and 4, respectively. At the end of the treatment, a complete local response was observed in 19 patients. With a median follow-up of 45 months (range, 12-78 months), 7 patients were alive in complete remission, of whom 6 had initially received a complete tumor resection. Overall survival rate at 3 years was 27% (95% confidence interval 10-44%) and median survival 10 months. In multivariate analysis, tracheal extension and macroscopic complete tumor resection were significant factors in overall survival. Death was related to local progression in 5% of patients, to distant metastases in 68%, and to both in 27%.
Main toxicity was hematologic. High long-term survival was obtained when RT-CT was given after complete surgery. This protocol avoided local tumor progression, and death was mainly caused by distant metastases.
分析一项在间变性甲状腺癌中联合手术、化疗（CT）和超分割加速放疗（RT）的前瞻性方案。
1990年至2000年期间，对30例间变性甲状腺癌患者（平均年龄59岁）进行了治疗。26例患者肿瘤侵犯超出甲状腺包膜，8例侵犯气管。18例患者有淋巴结转移，6例有肺转移。20例患者在放疗 - 化疗前进行了手术，4例在放疗 - 化疗后进行了手术。放疗前给予两个周期的阿霉素（60mg/m²）和顺铂（120mg/m²），放疗后给予四个周期。放疗包括每周5天，每天两次，每次1.25Gy，至颈部淋巴结区域和上纵隔的总剂量为40Gy。
急性毒性（根据世界卫生组织标准）方面，10例患者出现3级或4级咽食管炎；21例患者出现4级中性粒细胞减少，其中13例发生感染；8例和4例患者分别出现3级或4级贫血和血小板减少。治疗结束时，19例患者观察到局部完全缓解。中位随访45个月（范围12 - 78个月），7例患者存活且完全缓解，其中6例最初接受了肿瘤完全切除。3年总生存率为27%（95%置信区间10 - 44%），中位生存期为10个月。多因素分析显示，气管侵犯和肉眼可见的肿瘤完全切除是总生存的重要因素。5%的患者死亡与局部进展有关，68%与远处转移有关，27%与两者均有关。
主要毒性为血液学毒性。在完全手术后给予放疗 - 化疗可获得较高的长期生存率。该方案避免了局部肿瘤进展，死亡主要由远处转移引起。
