Abstract
Anaplastic thyroid cancer (ATC) is an unusual tumor with the worst prognosis among thyroid malignancies. Treatment of the patients diagnosed with ATC is not standardized and the feasible options include surgery, radiotherapy and chemotherapy. ATC cannot be regarded as a very chemo-sensitive tumor. Herein, we reported a case of a 91-year-old woman with complete response after induction chemotherapy (weekly carboplatin and docetaxel) that underwent subsequent radiotherapy.
1
Introduction
The number of newly diagnosed thyroid cancers has more than doubled during the last three decades. The global incidence of thyroid cancer is 6.1 per 100,000 people in male and 18.2 per 100,000 people in female . According to 2012 US cancer statistics, thyroid cancer is expected to be the fifth most commonly diagnosed cancer among women . Even though anaplastic thyroid cancer (ATC) accounts for less than 2% of all thyroid tumors, it is responsible for 14%–39% of thyroid carcinoma-related deaths, with a dismal median survival of 3–9 months and only 10%–15% of patients alive after 2 years .
At diagnosis, ATC is usually locally advanced and often metastatic: for these reasons ATC is frequently not resectable . Around 20%–25% of patients present with distant metastases, most often pulmonary ; another 25% of them develop metastases after diagnosis during the rapid course of disease. Because of its local, regional and systemic aggressive nature, ATC is classified as stage IV according to the American Joint Committee on Cancer, regardless of the tumor size or the presence of lymph node or distant metastasis .
Among the most important prognostic factors, age, gender, presence of distant metastasis and local extent have been recognized. In particular, younger female patients (< 65 years old), with a small (less than 5 cm or intra-thyroidal) ATC and without distant metastases at diagnosis, have a less severe prognosis .
The treatment of ATC patients has not been standardized and the feasible options nowadays include surgery, radiotherapy and chemotherapy. These treatment modalities should be combined in order to maximize the clinical outcome, in terms of both local and systemic disease control . Nevertheless, complete responses to treatment and long-term survivals are only anecdotal .
We herein report the case of a 91-year-old woman with complete response after induction chemotherapy (weekly carboplatin and docetaxel) followed by radiotherapy.
2
Case report
In February 2012, a 91-year-old woman with an enlarging anterior neck mass underwent ultrasound evaluation showing a thyroid nodular lesion of 1.4 cm with bilateral jugulo-digastric lymph node swelling. The fine needle aspiration biopsy (FNAB) was consistent with papillary carcinoma. Total thyroidectomy was planned.
In the subsequent weeks, the thyroid lesion rapidly increased in size, and the patient complained of dysphonia and neck pain. Because of the unusual growth for a papillary carcinoma, a new FNAB was performed and the final histological examination concluded for anaplastic thyroid carcinoma. A cytologic revision of the specimen was required: the diagnosis of ATC was confirmed ( Fig. 1 ).
A PET-CT scan was performed for staging: many areas of pathological accumulation of the tracer, largely confluent, affecting the enlarged thyroid lobes, were found. Moreover, the imaging revealed several positive cervical (levels III, and IV) bilateral lymph nodes ( Fig. 2 ).
For a rational therapeutic approach, a comprehensive geriatric assessment (CGA) was also used. The patient was rated as vulnerable, because of her comorbidities (heart failure and hypertension) and dependence on caregivers for daily activities. Despite the limitations resulting from the CGA, we decided to refer the patient to chemotherapy followed by radiation therapy. The patient underwent chemotherapy with weekly docetaxel and carboplatin weekly for 3 weeks, rest 1 (days 1, 8, 15, 28 with a dose of 60 mg each day). This schedule is used in our center as a palliative approach in patients with important co-morbidity and/or low performance status affected by head and neck squamous cell carcinoma.
At treatment beginning the neck circumference was 46 cm. At the end of the first cycle of chemotherapy the neck circumference was reduced to 42 cm, and no lymph nodes were palpable. After three cycles (nine administrations) of antiblastic therapy the circumference was 41 cm and a restaging was performed (with US evaluation and PET-CT scan). The radiological investigations revealed an almost complete response: the size of thyroid was in normal limits, with microcalcifications in the left lobe and a nodule of 4 mm in the right lobe. No pathological lymph nodes were observed. The PET-CT scan did not show a pathological tracer accumulation ( Fig. 3 ).
During therapy the patient did not complain of side effects, in particular no significant alteration in blood counts or gastrointestinal distress was diagnosed. At the end of the third cycle the patient experienced fatigue and onycopathy ( Fig. 4 ), for which the antiblastic treatment was stopped. The patient underwent then radiotherapy, also in view of the excellent obtained response.
In November 2012, radiotherapy (50 Gy/25f) was performed with good tolerance. In August 2013, a thyroid ultrasonography showed a diffusely inhomogeneous glandular structure, without evidence of nodular aspects.
2
Case report
In February 2012, a 91-year-old woman with an enlarging anterior neck mass underwent ultrasound evaluation showing a thyroid nodular lesion of 1.4 cm with bilateral jugulo-digastric lymph node swelling. The fine needle aspiration biopsy (FNAB) was consistent with papillary carcinoma. Total thyroidectomy was planned.
In the subsequent weeks, the thyroid lesion rapidly increased in size, and the patient complained of dysphonia and neck pain. Because of the unusual growth for a papillary carcinoma, a new FNAB was performed and the final histological examination concluded for anaplastic thyroid carcinoma. A cytologic revision of the specimen was required: the diagnosis of ATC was confirmed ( Fig. 1 ).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
