Endocrine Malignancies Disease Oriented Group, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, USA.
Thyroid. 2011 Jan;21(1):25-30. doi: 10.1089/thy.2010.0220. Epub 2010 Dec 16.
Historical outcomes in anaplastic thyroid carcinoma (ATC) are poor, with a median survival of only 5 months and <20% of patients surviving 1 year from diagnosis. We hypothesized that survival in newly diagnosed patients with stages IVA and IVB locoregionally confined ATC might be improved by utilizing an aggressive therapeutic approach, prioritizing both the eradication of disease in the neck and preemptive treatment of occult metastatic disease.
Between January 1, 2003, and December 31, 2007, 25 new ATC patients were evaluated at our institution. Of these 25 patients, 10 (40%) had metastatic disease at diagnosis and therefore underwent palliative treatment, whereas 5 (20%) had regionally confined disease and desired treatment at their local medical facilities. The remaining 10 consecutive patients (40%) had regionally confined ATC and elected aggressive therapy combining individualized surgery (where feasible), intensity-modulated radiation therapy (IMRT), and radiosensitizing + adjuvant chemotherapy intending four cycles of docetaxel + doxorubicin. Outcomes were assessed on an intention to treat basis.
There were no deaths from therapy, but hospitalization was required in two patients (20%) because of treatment-related adverse events. Five patients (50%) are alive and cancer-free, all having been followed >32 months (range: 32-89 months; median: 44 months) with a median overall Kaplan-Meier survival of 60 months. Overall survival at 1 and 2 years was 70% and 60%, respectively, compared to <20% historical survival at 1 year in analogous patients previously treated with surgery and conventional postoperative radiation at our and other institutions.
Although based upon a small series of consecutively treated patients, an aggressive approach combining IMRT and radiosensitizing plus adjuvant chemotherapy appears to improve outcomes, including survival in stages IVA and IVB regionally confined ATC, but remains of uncertain benefit in patients with stage IVC (metastatic) disease. Also uncertain is the optimal chemotherapy regimen to use in conjunction with IMRT. Further multicenter randomized trials are required to define optimal therapy in this rare but deadly cancer.
间变性甲状腺癌（ATC）的历史预后较差，中位生存期仅为 5 个月，<20%的患者从诊断起 1 年内存活。我们假设，通过采用积极的治疗方法，优先消除颈部疾病并预防性治疗隐匿性转移性疾病，可改善局部区域局限于IVA 和 IVB 期的新诊断 ATC 患者的生存。
2003 年 1 月 1 日至 2007 年 12 月 31 日，我们机构评估了 25 例新的 ATC 患者。其中 10 例（40%）患者在诊断时就已经有转移病灶，因此接受姑息治疗，5 例（20%）患者有局部区域疾病，希望在当地医疗机构接受治疗。其余 10 例连续患者（40%）患有局部区域 ATC，选择了联合个体化手术（可行时）、强度调制放射治疗（IMRT）和增敏+辅助化疗的积极治疗方案，旨在进行四周期多西紫杉醇+多柔比星治疗。采用意向治疗方法评估结果。
没有因治疗而死亡的病例，但有 2 例患者（20%）因治疗相关不良事件而需要住院治疗。5 例（50%）患者存活且无癌，所有患者均随访>32 个月（范围：32-89 个月；中位数：44 个月），Kaplan-Meier 中位总生存期为 60 个月。1 年和 2 年的总生存率分别为 70%和 60%，而在我们机构和其他机构，以前接受手术和常规术后放疗的类似患者，1 年的生存率<20%。
尽管该研究基于一系列连续治疗的患者，但联合 IMRT 和增敏+辅助化疗的积极治疗方法似乎可以改善预后，包括局部区域局限于IVA 和 IVB 期的 ATC 的生存，但在 IVC 期（转移性）疾病患者中的获益尚不确定。与 IMRT 联合使用的最佳化疗方案也不确定。需要进一步的多中心随机试验来确定这种罕见但致命的癌症的最佳治疗方法。
