Department of Surgery, Shizuoka Saiseikai General Hospital, 1-1-1 Ojika, Suruga-ku, Shizuoka 422-8527, Japan.
Jpn J Clin Oncol. 2011 Sep;41(9):1074-8. doi: 10.1093/jjco/hyr095. Epub 2011 Jul 26.
Although anaplastic thyroid carcinoma has a dismal prognosis, some patients show favorable survival following multimodal treatment with surgery, external irradiation and chemotherapy. However, no regimen has yet been established. We reviewed outcomes for patients who underwent a unique chemoradiotherapy regimen between 1998 and 2007.
The regimen consists of external irradiation (40 Gy at 2 Gy/day) combined with concurrent low-dose cisplatin at 5 mg/m(2) on Days 1-5, 8-12, 15-19 and 22-26, 5-fluorouracil at 200 mg/m(2) on Days 1-26 and doxorubicin at 20 mg/m(2) on Days 1 and 15. This regimen was performed on 21 patients (13 men, 8 women) with anaplastic thyroid carcinoma. Median age at the time of treatment was 66 years (range, 54-81 years).
The treatment regimen was completed in 19 patients (90%) and was interrupted in 2 (10%) due to progressive distant metastases. After excluding 10 patients who underwent complete resection before chemoradiotherapy, 1 patient (11%) showed partial response, 7 (78%) showed stable disease and 1 (11%) had progressive disease on the basis of Response Evaluation Criteria in Solid Tumors. Overall, 6-month survival rate for patients treated with chemoradiotherapy was 57%. With this novel chemoradiotherapy, death from loco-regional disease was seen in only two patients (11%). Grade 3-4 toxicities were observed in 12 patients (63%), but no treatment-related deaths were encountered.
Our new chemoradiotherapy is effective for loco-regional control of anaplastic thyroid carcinoma, particularly when combined with radical surgery. This regimen could not prevent distant metastases, but offers acceptable toxicity while maintaining patient quality of life.
尽管间变性甲状腺癌预后不良，但一些患者在接受手术、外照射和化疗等多模式治疗后，生存情况良好。然而，目前尚未确立任何治疗方案。我们回顾了 1998 年至 2007 年间接受独特的放化疗方案治疗的患者的结果。
该方案包括外照射（每天 2Gy，40Gy），同时给予顺铂低剂量（第 1-5、8-12、15-19 和 22-26 天，每次 5mg/m²）、氟尿嘧啶（第 1-26 天，每次 200mg/m²）和阿霉素（第 1 和 15 天，每次 20mg/m²）。该方案共治疗 21 例间变性甲状腺癌患者（男 13 例，女 8 例）。治疗时的中位年龄为 66 岁（范围 54-81 岁）。
19 例（90%）患者完成了治疗方案，2 例（10%）因进展性远处转移而中断治疗。在排除 10 例在放化疗前接受完全切除术的患者后，根据实体瘤反应评价标准，1 例（11%）患者部分缓解，7 例（78%）患者病情稳定，1 例（11%）患者病情进展。总的来说，接受放化疗的患者 6 个月生存率为 57%。采用这种新的放化疗方法，仅有 2 例患者（11%）死于局部区域疾病。12 例患者（63%）观察到 3-4 级毒性，但未发生与治疗相关的死亡。
我们的新放化疗方案对间变性甲状腺癌的局部区域控制有效，特别是与根治性手术联合使用时。该方案不能预防远处转移，但在保持患者生活质量的同时，毒性可接受。
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