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The Effect of Surgery and Radiotherapy on Outcome of Anaplastic Thyroid Carcinoma

From the Departments of Surgical Oncology (RDG, MJO), Cancer Statistics Center (AM), and Pathology (WCF), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Surgery, Medical Center Leeuwarden, The Netherlands (JPENP).

Correspondence: Address correspondence and reprint requests to: Mark J. Ott, MD, Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, 626 Cox Building, 100 Blossom St., Boston MA 02114; Fax: 617-724-3895; E-mail: ott.mark{at}mgh.harvard.edu

Background: Anaplastic thyroid carcinoma (ATC) is an aggressive rare tumor. We analyzed our experience for prognosis and the effect of surgery and radiotherapy on patients with ATC.

Methods: We conducted a retrospective review of all patients (n = 67) with ATC treated at a tertiary care center from 1969 to 1999. Survivor median follow-up was 51 months. Tumor and patient characteristics and therapy were assessed for effect on survival by multivariate analysis.

Results: Patients presented with a neck mass (99%), change of voice (51%), dysphagia (33%), and dyspnea (28%). Surgery was performed in 44 of 67 patients, with 12 complete resections. The 6-month and 1- and 3-year survival rates were 92%, 92%, and 83% after complete resection; 53%, 35%, and 0% after debulking; and 22%, 4%, and 0% after no resection, respectively (P < .0001). A radiation dose of >45 Gy improved survival as compared with a lower dose (P = .02). Multivariate analysis showed that age 70 years, absence of dyspnea or dysphagia at presentation, a tumor size 5 cm, and any surgical resection improved survival (P < .05).

Conclusions: Candidates for surgery with curative intent for ATC are patients 70 years, tumors 5 cm, and no distant disease. Radiotherapy >45 Gy improves outcome.

Key Words: Anaplastic thyroid cancer • Surgery • Radiotherapy • Debulking

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