Tennvall J, Lundell G, Hallquist A, Wahlberg P, Wallin G, Tibblin S
Department of Oncology, University Hospital, Lund, Sweden.
Cancer. 1994 Aug 15;74(4):1348-54. doi: 10.1002/1097-0142(19940815)74:4<1348::aid-cncr2820740427>3.0.co;2-d.
Anaplastic carcinoma of the thyroid (ACT) rarely can be cured, but every effort should be made to improve prognosis and, above all, prevent death due to suffocation or large local tumor ulceration.
From 1984 to 1992, 33 consecutive patients with ACT were treated prospectively according to a combined treatment program consisting of hyperfractionated radiotherapy, doxorubicin, and debulking surgery. Preoperative radiotherapy was administered to a target dose of 30 Gy and postoperatively to a total dose of 46 Gy. Radiotherapy was performed 5 days a week. The daily fraction was 1.0 Gy x 2 until 1988, after which it was 1.3 Gy x 2. Otherwise, the therapy remained unchanged. Twenty milligrams of doxorubicin were administered intravenously per week. Debulking surgery was possible in 23 patients (70%).
No patient failed to complete the protocol because of toxicity. There were no signs of local recurrence in 16 patients (48%). In only eight patients (24%) was death attributed to local failure. In four patients, survival with no evidence of disease exceeded 2 years. Improvement in local tumor control was marginally significant (P = 0.08) in the 17 patients treated in the latter part of the study, with no sign of local disease in 11 patients and deaths due to local failure in only 2 patients. The improved local control could not be attributed to any differences between the two series.
Combination modality treatment of ACT is feasible and effective despite the patients' advanced age and locally advanced disease. There was a tendency for local control to be improved after accelerated radiotherapy.
甲状腺未分化癌（ACT）很少能治愈，但应尽一切努力改善预后，最重要的是预防因窒息或巨大局部肿瘤溃疡导致的死亡。
1984年至1992年，对33例连续的ACT患者按照由超分割放疗、阿霉素和减瘤手术组成的联合治疗方案进行前瞻性治疗。术前放疗给予目标剂量30 Gy，术后给予总剂量46 Gy。放疗每周进行5天。1988年前每日分割剂量为1.0 Gy×2，之后为1.3 Gy×2。其他方面，治疗方案保持不变。每周静脉注射20毫克阿霉素。23例患者（70%）可行减瘤手术。
没有患者因毒性而未能完成治疗方案。16例患者（48%）无局部复发迹象。仅8例患者（24%）的死亡归因于局部失败。4例患者无疾病证据存活超过2年。在研究后期接受治疗的17例患者中，局部肿瘤控制的改善具有边缘显著性（P = 0.08），11例患者无局部疾病迹象，仅2例患者因局部失败死亡。局部控制的改善不能归因于两个系列之间的任何差异。
尽管患者年龄较大且局部疾病进展，但ACT的综合治疗方式是可行且有效的。加速放疗后局部控制有改善的趋势。
