Surgery, consisting of thyroidectomy with or without lymph node removal, was performed in 23 patients. Importantly, in 21 of the 23 surgically treated patients, anaplastic thyroid cancer was diagnosed only with surgical pathologic results. In other words, surgery was undertaken with a needle biopsy diagnosis of a more differentiated thyroid cancer. External beam radiation therapy was given to 22 patients following surgery and to an additional 27 patients as first-line treatment. Almost all patients underwent chemotherapy at the time of radiation therapy. An additional 18 patients were treated with chemotherapy as treatment for disease progression.
The average time to treatment failure was 3.8 months, and the average overall survival was 11.9 months. Cancer progression most commonly occurred in distant spread sites. Predictors of treatment failure and overall survival included advanced stage at presentation, male sex, and specific pathologic findings. Patients who were treated with surgery, radiation, and chemotherapy had improved median survival as compared with those treated with radiation and chemotherapy alone, leading the authors to conclude that complete surgical resection was the most important determinant of survival.
In genetic testing, there was no significant association found between the presence or number of mutations and clinical outcomes.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Anaplastic thyroid cancer has a very poor prognosis both because it is locally aggressive and because of its early spread to distant sites. Despite multiple treatment methods, the average survival in the current study was less than 2 years for patients who underwent surgical excision and only 6 months for those who underwent radiation and chemotherapy alone. Surgery for anaplastic thyroid cancer may extend survival and should be considered for patients in whom complete surgical removal may be possible. Though surgery may be helpful, it is also possible that this study is looking at a specially selected patients. More studies are needed to develop improved treatments.
— Ronald B. Kuppersmith, MD, FACS
ATA THYROID BROCHURE LINKS
Thyroid Surgery: http://www.thyroid. org/thyroid-surgery/
Thyroid cancer: http://www.thyroid.org/ cancer-of-the-thyroid-gland