Lorntzsen, Bianca1,2, Jacobsen, Anne Birgitte3, Grøholt, Krystyna4, Osnes, Terje1,2, Falk, Ragnhild5 Sigstad, Eva4
1 University of Oslo, Institute of Clinical Medicine, Oslo, Norway
2 Dept of Otorhinolaryngology,Head and Neck Surgery, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
3 Dept of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
4 Dept of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
5 Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
Background: ATC is one of the most aggressive cancers (1, 2). From 2002 our recommended treatment strategy has been HART with high doses (64 Gy) to the neck combined with doxorubicin, followed by surgery 4-8 weeks later if feasible.
Methods: Pathological review was performed by two senior thyroid pathologists to ensure the diagnosis of ATC, and thereby avoid possible misdiagnosis leading to falsely improved survival.
Fourteen patients underwent both HART and thyroid surgery in the period 2002-2014.
All patients with ATC diagnosed before start of treatment, had HART first. The six patients with postoperative HART, had other preoperative diagnoses on FNAC/CNB, and ATC was confirmed after surgery. One patient had surgery on recurrence (primary treatment HART only).
Results: Postoperative complications (hematoma, haemorrhage, infection, fistulae, chylous-leak) occurred in six of 14 of patients, and almost exclusively in patients who had surgery in an irradiated neck.
Four patients had tracheostomy during the course of the disease; two of them successfully decannulated after 14 and 105 days.
Median survival was 20 months (range 4 – 106):
18,5 (9 – 45) months in postoperative HART, 21 months (4 – 106) in preoperative HART.
The patient with surgery on recurrence survived 62 months.
Six patients survived more than 2 years, (range 30 – 106 months). Four of these had surgery in an irradiated neck.
Discussion/Conclusion: This material showed better long-time survival in patients with preoperative HART, but paying the price with more complications compared to postoperative HART. Overall survival compares well with literature reports (1).
- Bisof V, Rakusic Z, Despot M. Treatment of patients with anaplastic thyroid cancer during the last 20 years: whether any progress has been made? Eur Arch Otorhinolaryngol. 2015;272(7):1553-67.
- Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012;22(11):1104-39.