Anaplastic Thyroid Cancer: A Review of Epidemiology, Pathogenesis, and Treatment

Table 1

Chart review and retrospective studies.

Authors	Year	Site	No. of pts	Study details	Results
Swaak-Kragten et al. [30]	2009	Netherlands	75	Chart Review; 1972–2003	When treated with Doxorubicin and radiation, the median survival was 3 months. 1 yr OS was 9%. Locoregional control was significantly higher in patients who had undergone R0/R1 resection or chemoradiation, with best results for patients who underwent both (complete remission in 89%).
Vrbic et al. [31]	2009	Serbia	16	Chart Review 1997–2007	Radiation was combined with doxorubicin 60 mg/m^2 and cisplatin 40 mg/m^2 every 3 weeks. Overall response rate was of 25% (95% CI: 7–55). Mean patient OS was 12.33 months (95% CI: 9.09–15.56) and median OS 11.0 months (95% CI: 8.56–13.44).
Yau et al. [32]	2008	Hong Kong	50	Chart review; 1996–2006	Median survival was 97 days. On univariate analysis, age ≤ 65 (𝑃≤.01), absence of metastatic disease at presentation (𝑃<.01), surgical resection (𝑃<.01), and postoperative radiotherapy was associated with longer survival. Cytotoxic chemotherapy was not associated with longer survival.
Lim et al. [33]	2007	USA	37	Chart review; 1984–2006	A median radiation of dose 5760 cGy, >4500 cGy in 32 (87%) was administered through hyperfractionated or once-daily schedules. Median number of treatments received 6, >4 in 24 (65%). 2-year outcomes: locoregional control 25%; progression free survival 8%; overall survival 18%. 6 patients remained alive at the time of last followup with survival durations of 4, 11, 12, 57, 59, and 141 months, respectively.
Lee et al. [34]	2006	Korea	15	Chart review 1988–2003	The mean overall survival time of the 15 patients was 237 days (range, 28–717 days). The 6, 12, 18, and 24-month survival rates were 33%, 26%, 13%, and 0%.
Wang et al. [35]	2006	Canada	47	Chart review; 1983–2004	The 6-month local progression-free success rate was 95% (𝑃=.0001) with radical radiotherapy > 40 Gy compared to 64% with palliative radiotherapy at <40 Gy. Survival was 11 months with radical and 3 months with palliative (𝑃=.0001). The median overall survival time in patients with twice-daily fractionation (13 months) was 3 months longer than patients treated with once-daily fractionation (10 months), but the difference was not statistically significant (𝑃=.3).
Veness et al. [36]	2004	Australia	18	Chart review 1979–2002	Median survival was 6.2 months.
Haigh et al. [6]	2001	Canada	33	Chart review	In patients treated with potentially curative resection, median survival was 43 months and was 3 months with palliative resection (𝑃=.002). The median survival of 3.3 months with only chemotherapy and irradiation and palliative resection (𝑃=.63).
McIver et al. [27]	2001	USA	134	Chart review; 1949–1999	Extent of resection or completeness of resection did not affect survival. (𝑃>.4). Postoperative radiotherapy improved median survival (5 versus 3 months) but was not significant (𝑃<.08).
Besic et al. [37]	2001	Slovenia	162	Chart review; 1972–1998	82 patients with distant metastasis at presentation were excluded. Patients were divided into primary surgery (𝑛=26) or primary chemotherapy and/or radiation therapy. One-year survival was similar in both groups (𝑃=.17).
Sugino et al. [38]	2002	Japan	40	Chart review 1989–1999	The one-year survival rate for surgery was 60%. The survival rate without surgery was 21%. Surgery and chemotherapy were both used in some patients. One-year survival rates for patients with small focus of anaplastic thyroid cancer with well-differentiated thyroid cancer were 73%.
Heron et al. [39]	2002	USA	32	Chart review 1952–1999	Patients were divided into two groups. Group 1 patients between 1952–80 (𝑛=9) and Group 2 between 1981–1999 (𝑛=23). Group 1 patients received once daily radiation and Group 2 patients twice-daily radiation with chemotherapy of doxorubicin, pacitaxel, vincristine, or cisplatin There was a combination of therapies in both groups, with the above generalizations. 2-year survival was 44% in group 1 and 52% in group 2. Progression-free survival was 53% group 1 and 38% group 2. The authors concluded that hyperfractionated radiation with chemotherapy is associated with better survival but not progression-free survival.
Nilsson et al. [18]	1998	Sweden	81	Chart review; 1971–1997	Eight patients (10%) survived more than 2 years and were treated with combinations of chemotherapy, radiotherapy, and surgery.
Tennevall et al. [40]	1994	Sweden	33	Chart review; 1984–1992	Combination of hyperfractionated radiotherapy, doxorubicin, and debulking surgery. Preoperative radiation up to 30 Gy and post operative radiation up to 46 Gy. 20 mg doxorubicin per week. 48% had no local recurrence and, 24% died due to local failure. In 4 patients survival exceeded 2 yrs. Local control better with accelerated radiation therapy.
Venkatesh et al. [24]	1990	USA	121	Chart review	Median survival was 7.2±10 months.  35% patients had well-differentiated thyroid cancer as well.
Junor et al. [10]	1992	UK	91	Chart review 1961–1986	Surgery and radiation were used. Total or partial thyroidectomy increased survival. 80% responded to radiation therapy.
Levendag et al. [41]	1993	Holland	51	Chart review 1970–1986	Local control achieved a median survival of 7.5 months and local residual disease 1.6 months.
Kim and Leeper [12]	1987	USA	41	Chart review; 1979–1986	Only reporting Group 2 with anaplastic thyroid cancer. Weekly doxorubicin 10 mg/m^2 prior to hyperfractionated radiotherapy with 160 cGy twice daily to total 57–60 cGy in 40 days. Initial complete remission rate was 84%. Local tumor control at 2 years was 68% with combined therapy. Median survival was 1 year.