Combined doxorubicin, hyperfractionated radiotherapy, and surgery in anaplastic thyroid carcinoma. Report on two protocols. The Swedish Anaplastic Thyroid Cancer Group

Anaplastic carcinoma of the thyroid (ACT) rarely can be cured, but every effort should be made to improve prognosis and, above all, prevent death due to suffocation or large local tumor ulceration. From 1984 to 1992, 33 consecutive patients with ACT were treated prospectively according to a combined...

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Bibliographic Details
Published in:Cancer 1994-08, Vol.74 (4), p.1348
Main Authors: Tennvall, J, Lundell, G, Hallquist, A, Wahlberg, P, Wallin, G, Tibblin, S
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Carcinoma - drug therapy
Carcinoma - pathology
Carcinoma - radiotherapy
Carcinoma - secondary
Carcinoma - surgery
Clinical Protocols
Combined Modality Therapy
Doxorubicin - administration & dosage
Doxorubicin - therapeutic use
Feasibility Studies
Female
Humans
Lung Neoplasms - secondary
Male
Middle Aged
Neoplasm Recurrence, Local
Postoperative Care
Preoperative Care
Prospective Studies
Radiotherapy Dosage
Radiotherapy, High-Energy
Survival Rate
Thyroid Neoplasms - drug therapy
Thyroid Neoplasms - pathology
Thyroid Neoplasms - radiotherapy
Thyroid Neoplasms - surgery
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Summary:Anaplastic carcinoma of the thyroid (ACT) rarely can be cured, but every effort should be made to improve prognosis and, above all, prevent death due to suffocation or large local tumor ulceration. From 1984 to 1992, 33 consecutive patients with ACT were treated prospectively according to a combined treatment program consisting of hyperfractionated radiotherapy, doxorubicin, and debulking surgery. Preoperative radiotherapy was administered to a target dose of 30 Gy and postoperatively to a total dose of 46 Gy. Radiotherapy was performed 5 days a week. The daily fraction was 1.0 Gy x 2 until 1988, after which it was 1.3 Gy x 2. Otherwise, the therapy remained unchanged. Twenty milligrams of doxorubicin were administered intravenously per week. Debulking surgery was possible in 23 patients (70%). No patient failed to complete the protocol because of toxicity. There were no signs of local recurrence in 16 patients (48%). In only eight patients (24%) was death attributed to local failure. In four patients, survival with no evidence of disease exceeded 2 years. Improvement in local tumor control was marginally significant (P = 0.08) in the 17 patients treated in the latter part of the study, with no sign of local disease in 11 patients and deaths due to local failure in only 2 patients. The improved local control could not be attributed to any differences between the two series. Combination modality treatment of ACT is feasible and effective despite the patients' advanced age and locally advanced disease. There was a tendency for local control to be improved after accelerated radiotherapy.
ISSN:0008-543X
1097-0142