Nachalon Yuval, Stern-Shavit Sagit, Bachar Gideon, Shvero Jacob, Limon Dror, Popovtzer Aron
Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel3Head and Neck Tumor Unit, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.
JAMA Otolaryngol Head Neck Surg. 2015 Dec;141(12):1128-32. doi: 10.1001/jamaoto.2015.2332.
Anaplastic thyroid carcinoma is an undifferentiated aggressive tumor with a high rate of regional and distant spread and a grave prognosis (median survival, 3 months) with no standardized treatment.
To review the effect of an active treatment policy on the outcome of anaplastic thyroid carcinoma.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective comparative study of all patients diagnosed as having anaplastic thyroid carcinoma and undergoing treatment from January 1, 2008, through December 31, 2013, in a tertiary university-affiliated medical center. Data were collected by medical record review. Final follow-up was completed on November 30, 2014. Data were analyzed from December 1 to 3, 2014.
Treatment options included surgery and adjuvant concomitant radiotherapy and chemotherapy with doxorubicin hydrochloride or paclitaxel for local disease; full-dose chemoradiotherapy (70 Gy to the gross tumor) for local disease when surgery was not feasible; aggressive palliative radiotherapy (50 Gy to the gross tumor) for metastatic disease; and palliative radiotherapy (≤ 30 Gy) for metastatic disease with a low performance status.
Survival time and quality of life.
Of the 26 patients (including 15 women) who met the inclusion criteria, 11 underwent radiotherapy with curative intent. These patients included 5 who underwent curative surgery (5 with chemotherapy) and 6 who received primary chemotherapy. Nine patients received aggressive palliative radiotherapy, and 3 received palliative radiotherapy. The remaining 3 patients were not treated. Curative radiotherapy was associated with a significantly longer overall median (95% CI) survival time (11 [8.1-13.9] months) than aggressive palliative radiotherapy (6 [3.1-8.9] months), palliative radiotherapy (3 [0.0-7.8] months), and no treatment (1 month) (P < .001). Chemotherapy in 10 patients had a significant effect on survival (mean [95% CI], 11 [1.2-6.8] vs 4 [8.1-13.9] months for patients who did not receive chemotherapy; P = .01). Among the patients who underwent surgery and curative radiotherapy, 3 were alive after more than 3 years of follow-up. No association of survival with patient sex (median [95% CI] survival for men and women, 9 [3.6-14.4] and 5 [0.3-9.7] months, respectively; P = .54) or a history of thyroid disease (median [95% CI] survival for those with and without, 4 [1.0-6.9] and 9 [5.4-12.5] months, respectively; P = .15) was found.
Anaplastic thyroid carcinoma has a grave prognosis, but an aggressive approach, including surgery, chemotherapy, and radiotherapy, seems to improve survival. Higher doses of radiotherapy may have a survival benefit in candidates for palliative treatment and may be considered for patients with extensive disease.
间变性甲状腺癌是一种未分化的侵袭性肿瘤，局部和远处转移率高，预后严重（中位生存期3个月），且尚无标准化治疗方法。
回顾积极治疗策略对间变性甲状腺癌治疗结果的影响。
设计、地点和参与者：对2008年1月1日至2013年12月31日在一所大学附属三级医疗中心被诊断为间变性甲状腺癌并接受治疗的所有患者进行回顾性比较研究。通过病历审查收集数据。最终随访于2014年11月30日完成。数据分析于2014年12月1日至3日进行。
治疗方案包括手术以及对局部病变采用辅助同步放化疗，使用盐酸多柔比星或紫杉醇；若手术不可行，则对局部病变采用全量放化疗（肿瘤大体体积给予70 Gy）；对转移性病变采用积极姑息性放疗（肿瘤大体体积给予50 Gy）；对功能状态差的转移性病变采用姑息性放疗（≤30 Gy）。
生存时间和生活质量。
符合纳入标准的26例患者（包括15名女性）中，11例接受了根治性放疗。这些患者包括5例接受根治性手术的患者（5例接受化疗）和6例接受初始化疗的患者。9例患者接受了积极姑息性放疗，3例接受了姑息性放疗。其余3例患者未接受治疗。根治性放疗的总体中位（95%CI）生存时间（11[8.1 - 13.9]个月）显著长于积极姑息性放疗（6[3.1 - 8.9]个月）、姑息性放疗（3[0.0 - 7.8]个月）和未治疗（1个月）（P<0.001）。10例患者接受化疗对生存有显著影响（未接受化疗患者的平均[95%CI]生存时间为4[8.1 - 13.9]个月，接受化疗患者为11[1.2 - 6.8]个月；P = 0.01）。在接受手术和根治性放疗的患者中，3例在随访超过3年后仍存活。未发现生存与患者性别（男性和女性的中位[95%CI]生存时间分别为9[3.6 - 14.4]个月和5[0.3 - 9.7]个月；P = 0.54）或甲状腺疾病史（有甲状腺疾病史和无甲状腺疾病史患者的中位[95%CI]生存时间分别为4[1.0 - 6.9]个月和9[5.4 - 12.5]个月；P = 0.15）有关。
间变性甲状腺癌预后严重，但包括手术、化疗和放疗在内的积极治疗方法似乎可提高生存率。更高剂量的放疗可能对姑息治疗的患者有生存益处，对于病变广泛的患者可考虑采用。
