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Choi, Kim, Lee, Song, Chung, Lee, Kim, Choi, Kim, Cho, Rhee, Ahn, Lim, and Kim: The Effect of Treatment Modalities on Survival Rates of Patients with Anaplastic Thyroid Carcinoma
Original Article
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2005; 20(2): 127-133.

Published online: 20 April 2005

DOI: https://doi.org/10.3803/jkes.2005.20.2.127

The Effect of Treatment Modalities on Survival Rates of Patients with Anaplastic Thyroid Carcinoma

Jae Myoung Choi, Mi Jeong Kim, Seung Won Lee, Kyoung Eun Song, Yoon-Sok Chung, Kwan Woo Lee, Dae Jung Kim, Sung Hee Choi1, So Hun Kim2, Min Ho Cho2, Yumie Rhee2, Chul Woo Ahn2, Sung Kil Lim2, Kyung Rae Kim2

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

1Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Received 11 August 2004       Accepted 1 February 2005

Copyright © 2005 Korean Endocrine Society

Abstract

Background

Anaplastic thyroid carcinoma represents 2% to 5% of all thyroid cancers and it is one of the most aggressive human cancers. Local extension at the time of diagnosis and distant metastases are almost always the rule. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival time of 4 months. We retrospectively reviewed patients with this disease at 4 tertiary referral centers.

Methods

From 1990 to 2003, 19 cases (9 men and 10 women, mean age: 65.1 ± 7.1 years) of anaplastic thyroid carcinoma were reviewed via the medical records. The overall survival rates according to the prognostic factors and the treatment modalities were analyzed.

Results

The presenting symptoms included rapidly enlarged neck masses in 16 patients, shortness of breath in 3 patients, hoarseness in 4 patients, dysphagia in 2 patients and chest wall pain in 1 patient. The mean diameter of tumor was 7.2 cm. Local extension was seen in all of the cases that had undergone surgery. Distant metastases (lung 6, bone 2, abdominal carcinomatosis 2, brain 1 and mediastinum 1) were seen in 9 patients. Surgical treatment was performed in 10 patients. Radiotherapy was performed in 9 patients and chemotherapy was done in 5 patients; radiotherapy was performed alone in 2 patients, combination chemo-radiotherapy was performed in 3 patients, postoperative radiotherapy was performed in 2 patients and postoperative combination chemo-radiotherapy was performed in 2 patients. 4 patients were treated cons ervatively after the confirmative diagnosis. The overall median survival time was 123 days (range: 23~621 days); the median survival time was 129 days in the treatment group (n=15), and 27 days in the no treatment group (n=4), and significantly higher survival rates were observed for the treated patients (p=0.02). According to the treatment modalities, patients who underwent surgical treatment and postoperative radiotherapy and/or chemotherapy were observed to have significantly higher survival rates than patients in the radiotherapy and/or chemotherapy group (p=0.03), and also than those patients in the surgical treatment only group (p=0.04).

Conclusion

We found that aggressive surgical treatment and postoperative radiotherapy and/or chemotherapy improved the survival rates of patients with anaplastic thyroid carcinoma even though local invasion and distant metastases was generally observed to occur.

Keywords: Anaplastic thyroid carcinoma, Surgery, Treatment modalities, Treatment outcome

Figures and Tables

Fig. 1
Overall cumulative survival rates of 19 patients with anaplastic thyroid carcinoma
jkse-20-127-g001
Fig. 2
Cumulative survival rates of patients with anaplastic thyroid carcinoma according to the treatment. Significantly higher survival rates were observed in treated patients (P = 0.02)
jkse-20-127-g002
Fig. 3
Cumulative survival rates of patients with anaplastic thyroid carcinoma according to the treatment modalities. Significantly higher survival rates were observed in patients treated by surgical treatment and postoperative radiotherapy and/or chemotherapy.
jkse-20-127-g003
Table 1
Clinical Characteristics of 20 Cases of Anaplastic Thyroid Carcinoma
jkse-20-127-i001

(*: exclude case due to pathologic finding that was composed to papillary cancer with 30% anaplastic reaction)

Table 2
Factors Associated with Survival in Patients with Anaplastic Thyroid Carcinoma
jkse-20-127-i002

*; exclude two cases with debulking surgery

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