The effect of surgery and radiotherapy on outcome of anaplastic thyroid carcinoma

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 less than or equal to70 years, absence of dyspnea or dysphagia at presentation, a tumor size :55 cm, and any surgical resection improved survival (P < .05). Conclusions: Candidates for surgery with curative intent for ATC are patients :570 years, tumors less than or equal to5 cm, and no distant disease. Radiotherapy >45 Gy improves outcome.