Department of Radiation Oncology, Jean Minjoz University Teaching Hospital, Boulevard Flemming, Besançon F-25000, France.
Crit Rev Oncol Hematol. 2013 Jun;86(3):290-301. doi: 10.1016/j.critrevonc.2012.10.006. Epub 2012 Dec 4.
ATC represents 1-2% of all thyroid carcinomas. Median survival is poor (3-10 months). Our goal is to update recommendations for RT in the context of new irradiation techniques.
A search of the French and English literature was performed with terms: thyroid carcinoma, anaplastic, chemoradiation, radiation therapy and surgery. Level-based evidence remains limited in the absence of prospective studies and the small size of retrospective series of this rare tumor.
Surgery when possible should be as complete as possible but without mutilation given the 8-month median survival of ATC. It should be followed by systematic chemoradiation in ATC. Initiation of treatment is an emergency given fast tumor doubling time. The most promising results of chemoradiation to date have been shown in series of radiation therapy (+/- acceleration) combined with doxorubicin +/- taxanes or cisplatin. Adjuvant chemotherapy (doxorubicin, cisplatine and/or taxane-based) may also be recommended given the metastatic potential of ATC and warrants further investigations. Data on neoadjuvant chemotherapy are missing. Intensity modulated radiation therapy offers clear dosimetric advantages and has the potential to improve tumor and nodal (posterior neck, mediastinum) coverage, i.e., locoregional control while optimally sparing the spinal cord, larynx, parotids, trachea and esophagus. PET-CT and MRI may be used for RT planning.
Chemoradiation with debulking surgery whenever possible is the mainstay of treatment of anaplastic thyroid carcinomas (ATC). EBRT using IMRT has the potential to improve local control. Taxane-doxorubicin concomitant chemoradiotherapy is worth further investigation.
间变甲状腺癌（ATC）占所有甲状腺癌的 1-2%。中位生存期较差（3-10 个月）。我们的目标是在新的放疗技术背景下更新对放疗的建议。
使用法语和英语文献中的术语搜索，包括甲状腺癌、间变、放化疗、放射治疗和手术。由于缺乏前瞻性研究以及这种罕见肿瘤的回顾性系列研究规模较小，基于水平的证据仍然有限。
如果可能，手术应尽可能完整，但考虑到 ATC 的 8 个月中位生存期，不应致残。在 ATC 中，应在手术后进行系统的放化疗。由于肿瘤倍增时间较快，因此治疗的开始是紧急情况。迄今为止，在放疗（+/- 加速）联合多柔比星（/-）紫杉类药物或顺铂的系列研究中，放化疗显示出最有希望的结果。鉴于 ATC 的转移性潜力，还可能推荐辅助化疗（多柔比星、顺铂和/或紫杉类药物为基础），这需要进一步研究。缺少关于新辅助化疗的数据。调强放疗（IMRT）提供了明确的剂量优势，有可能改善肿瘤和淋巴结（后颈部、纵隔）的覆盖，即局部区域控制，同时最大限度地保护脊髓、喉、腮腺、气管和食管。PET-CT 和 MRI 可用于 RT 计划。
尽可能进行减瘤手术的放化疗是间变甲状腺癌（ATC）的主要治疗方法。EBRT 使用 IMRT 有可能提高局部控制率。紫杉类药物联合多柔比星放化疗值得进一步研究。
