Anaplastic thyroid carcinoma - current issues of today (according to NCCN Guidelines)
Abstract
Aim.To consider the current state of the problem of treatment patients with anaplastic thyroid carcinoma.
Material and Methods. Twenty-one cases of anaplastic thyroid carcinoma were analyzed in patients from the Lviv Regional Clinical Hospital (n=9) and Lviv Regional Treatment and Diagnostical Cancer Center (n = 12) from 2004 to 2017. The approaches to treatment of anaplastic thyroid carcinoma on the basis of NCCN Guidelines over the year of 2018 are shown.
Results and Discussion. Anaplastic thyroid carcinoma was more common in women - 15 cases (71,4%) than in men - 6 cases (28,6%). A diagnosis of anaplastic thyroid carcinoma was established as a result of core-biopsy in 12 (57,1%) patients; in 9 (42,9%) cases the verification was obtained after surgery. The average age of patients at the time of diagnosis was 70,9±7,5 years. Radical thyroidectomy was performed in 5 (23,8%) patients. Palliative radiation therapy was used in 3 (14,3%) patients; 4 patients had combined treatment - thyroidectomy and postoperative course of radiation therapy. Remaining 9 (42,9%) cases had symptomatic therapy; out of those, in 2 cases tracheostomy was performed due to a compression of the upper respiratory tract by the tumor. In general, there was no relationship between the type of performed treatment and the overall survival rate of the patients (р>0,05). In our study, the average of survival time was 4,2±3,9 months, and the one-year survival rate was 9,5% (n = 2).
Conclusions. The results of treatment for patients with anaplastic thyroid carcinoma are currently unsatisfactory - median overall survival is only 3 months, although these data are consistent with world literature. Factors provoking this disease are not detected, and the mechanisms leading to transformation of differentiated cancer to anaplastic are not defined. All these facts require further study and clinical research.
References
Akaishi J, Sugino K, Kitagawa W, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid 2011;21:1183-1189. https://doi.org/10.1089/thy.2010.0332
Antonelli A, Fallahi P, Ulisse S, et al. New targeted therapies for anaplastic thyroid cancer. Anticancer Agents Med Chem 2012;12:87-93. https://doi.org/10.2174/187152012798764732
Are C, Shaha AR. Anaplastic thyroid carcinoma: biology, pathogenesis, prognostic factors, and treatment approaches. Ann Surg Oncol 2006;13:453-464. https://doi.org/10.1245/ASO.2006.05.042
Bible KC, Suman VJ, Menefee ME, et al. A multiinstitutional phase 2 trial of pazopanib monotherapy in advanced anaplastic thyroid cancer. J Clin Endocrinol Metab 2012;97:3179-3184. https://doi.org/10.1210/jc.2012-1520
Brierley J, Sherman E. The role of external beam radiation and targeted therapy in thyroid cancer. Semin Radiat Oncol 2012;22:254-262. https://doi.org/10.1016/j.semradonc.2012.03.010
Burnison CM, Lim S. Multimodal approach to anaplastic thyroid cancer. Oncology (Williston Park) 2012;26:378-384, 390-378.
Chou A, Fraser S, Toon CW, et al. A detailed clinicopathologic study of ALK-translocated papillary thyroid carcinoma. Am J Surg Pathol 2015;39:652-659. https://doi.org/10.1097/PAS.0000000000000368
Clinical Practice Guidelines in Oncology (NCCN Guidelines): Thyroid Carcinoma, Version 3.2018-140 p.
Derbel O, Limem S, Segura-Ferlay C, et al. Results of combined treatment of anaplastic thyroid carcinoma (ATC). BMC Cancer 2011;11:469. https://doi.org/10.1186/1471-2407-11-469
Dumke AK, Pelz T, Vordermark D. Long-term results of radiotherapy in anaplastic thyroid cancer. Radiat Oncol 2014;9:90. https://doi.org/10.1186/1748-717X-9-90
Foote RL, Molina JR, Kasperbauer JL, et al. Enhanced survival in locoregionally confined anaplastic thyroid carcinoma: a single-institution experience using aggressive multimodal therapy. Thyroid 2011;21:25-30. https://doi.org/10.1089/thy.2010.0220
Ha HT, Lee JS, Urba S, et al. A phase II study of imatinib in patients with advanced anaplastic thyroid cancer. Thyroid 2010;20:975-980. https://doi.org/10.1089/thy.2010.0057
Howlader N, Noone A, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2014, based on November 2016 SEER data submission, posted to the SEER web site, April 2017. Bethesda, MD: National Cancer Institute; 2017.
Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005;103:1330-1335. https://doi.org/10.1002/cncr.20936
Kelly LM, Barila G, Liu P, et al. Identification of the transforming STRN-ALK fusion as a potential therapeutic target in the aggressive forms of thyroid cancer. Proc Natl Acad Sci U S A 2014;111:4233-4238. https://doi.org/10.1073/pnas.1321937111
Keutgen XM, Sadowski SM, Kebebew E. Management of anaplastic thyroid cancer. Gland Surg 2015;4:44-51.
Kunstman JW, Juhlin CC, Goh G, et al. Characterization of the mutational landscape of anaplastic thyroid cancer via whole-exome sequencing. Hum Mol Genet 2015; 24: 2318-2329. https://doi.org/10.1093/hmg/ddu749
Maatouk J, Barklow TA, Zakaria W, Al-Abbadi MA. Anaplastic thyroid carcinoma arising in long-standing multinodular goiter following radioactive iodine therapy: report of a case diagnosed by fine needle aspiration. Acta Cytol 2009;53:581-583. https://doi.org/10.1159/000325388
Mani N, McNamara K, Lowe N, et al. Management of the compromised airway and role of tracheotomy in anaplastic thyroid carcinoma. Head Neck 2016;38:85-88. https://doi.org/10.1002/hed.23857
Mohebati A, Dilorenzo M, Palmer F, et al. Anaplastic thyroid carcinoma: a 25-year single-institution experience. Ann Surg Oncol 2014;21:1665-1670. https://doi.org/10.1245/s10434-014-3545-5
Nachalon Y, Stern-Shavit S, Bachar G, et al. Aggressive Palliation and Survival in Anaplastic Thyroid Carcinoma. JAMA Otolaryngol Head Neck Surg 2015;141:1128-1132. https://doi.org/10.1001/jamaoto.2015.2332
Nagaiah G, Hossain A, Mooney CJ, et al. Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment. J Oncol 2011; 2011: 542358. https://doi.org/10.1155/2011/542358
Park G, Kim TH, Lee HO, et al. Standard immunohistochemistry efficiently screens for anaplastic lymphoma kinase rearrangements in differentiated thyroid cancer. Endocr Relat Cancer 2015;22:55-63. https://doi.org/10.1530/ERC-14-0467
Park JW, Choi SH, Yoon HI, et al. Treatment outcomes of radiotherapy for anaplastic thyroid cancer. Radiat Oncol J 2018;36:103-113. https://doi.org/10.3857/roj.2018.00045
Perot G, Soubeyran I, Ribeiro A, et al. Identification of a recurrent STRN/ALK fusion in thyroid carcinomas. PLoS One 2014;9:e87170. https://doi.org/10.1371/journal.pone.0087170
Rao SN, Zafereo M, Dadu R, et al. Patterns of Treatment Failure in Anaplastic Thyroid Carcinoma. Thyroid 2017;27:672-681. https://doi.org/10.1089/thy.2016.0395
Rosove MH, Peddi PF, Glaspy JA. BRAF V600E inhibition in anaplastic thyroid cancer. N Engl J Med 2013;368:684-685. https://doi.org/10.1056/NEJMc1215697
Savvides P, Nagaiah G, Lavertu P, et al. Phase II trial of sorafenib in patients with advanced anaplastic carcinoma of the thyroid. Thyroid 2013;23:600-604. https://doi.org/10.1089/thy.2012.0103
Siironen P, Hagstrom J, Maenpaa HO, et al. Anaplastic and poorly differentiated thyroid carcinoma: therapeutic strategies and treatment outcome of 52 consecutive patients. Oncology 2010;79:400-408. https://doi.org/10.1159/000322640
Smallridge RC, Ain KB, Asa SL, et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 2012;22:1104-1139. https://doi.org/10.1089/thy.2012.0302
Smallridge RC. Approach to the patient with anaplastic thyroid carcinoma. J Clin Endocrinol Metab 2012;97:2566-2572. https://doi.org/10.1210/jc.2012-1314
Sosa JA, Balkissoon J, Lu SP, et al. Thyroidectomy followed by fosbretabulin (CA4P) combination regimen appears to suggest improvement in patient survival in anaplastic thyroid cancer. Surgery 2012;152:1078-1087. https://doi.org/10.1016/j.surg.2012.08.036
Sosa JA, Elisei R, Jarzab B, et al. Randomized safety and efficacy study of fosbretabulin with paclitaxel/carboplatin against anaplastic thyroid carcinoma. Thyroid 2014;24:232-240. https://doi.org/10.1089/thy.2013.0078
Stavas MJ, Shinohara ET, Attia A, et al. Short course high dose radiotherapy in the treatment of anaplastic thyroid carcinoma. J Thyroid Res 2014;2014:764281. https://doi.org/10.1155/2014/764281
Subbiah V, Kreitman RJ, Wainberg ZA, et al. Dabrafenib and Trametinib Treatment in Patients With Locally Advanced or Metastatic BRAF V600-Mutant Anaplastic Thyroid Cancer. J Clin Oncol 2018;36:7-13. https://doi.org/10.1200/JCO.2017.73.6785
Sugitani I, Miyauchi A, Sugino K, et al. Prognostic factors and treatment outcomes for anaplastic thyroid carcinoma: ATC Research Consortium of Japan cohort study of 677 patients. World J Surg 2012;36:1247-1254. https://doi.org/10.1007/s00268-012-1437-z
Untch BR, Olson JA, Jr. Anaplastic thyroid carcinoma, thyroid lymphoma, and metastasis to thyroid. Surg Oncol Clin N Am 2006;15:661-679. https://doi.org/10.1016/j.soc.2006.05.006
U.S. Food and Drug Administration. FDA approves dabrafenib plus trametinib for anaplastic thyroid cancer with BRAF V600E mutation. 2018.
U.S. Food and Drug Administration. FDA approves larotrectinib for solid tumors with NTRK gene fusions. 2018.
This work is licensed under a Creative Commons Attribution 4.0 International License.
ISSN 
ISSN 
