title: Multimodality treatment for anaplastic thyroid carcinoma--treatment outcome in 75 patients.
abstract: OBJECTIVE
  To retrospectively analyze the outcome of patients with anaplastic thyroid carcinoma (ATC) treated in the Erasmus MC.
  
  
  METHODS
  Seventy-five ATC-patients were treated between 1972 and 2003. Mean age was 68 years. Tumor stage was IVA in 9%, IVB in 51%, and IVC in 40%. Thirty-six patients underwent up-front surgery, with 53% resulting in R0/R1 resection. Before 1988 adjuvant treatment consisted of conventional radiotherapy (RT) and/or chemotherapy (CT). As of 1988, 30 eligible patients were enrolled in a newly designed protocol. This consists of locoregional RT in 46 fractions of 1.1 Gy, given twice daily, followed by prophylactic irradiation of the lungs (PLI) in 5 daily fractions of 1.5 Gy. During radiation, low-dose Doxorubicine (15 mg/m(2)) is administered weekly and is followed by adjuvant Doxorubicine (50 mg/m(2)) 3-weekly up to a cumulative dose of 550 mg/m(2). Twenty-five ineligible patients were treated conventionally.
  
  
  RESULTS
  Overall median survival was 3 months, 1-year OS 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%). However, the survival benefit of patients who reached CR remained borderline (median OS 7 months, 1-year OS 32%). Three patients survived for more than 5 years; all had undergone R0/R1 surgical resection and chemoradiation. Acute toxicity in the protocol group was significantly higher than in the nonprotocol group, with 46% versus 11% grade 3 pharyngeal and/or esophageal toxicity.
  
  
  CONCLUSIONS
  Despite the ultimately dismal prognosis of ATC-patients, multimodality treatment significantly improved local control and improved the median survival.
authors.affiliation: Department of Radiation Oncology, Erasmus MC/Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands. a.swaak@erasmusmc.nl
authors.forename: Annemarie T
authors.initials: AT
authors.lastname: Swaak-Kragten
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Paul I M
authors.initials: PI
authors.lastname: Schmitz
authors.forename: Marijke
authors.initials: M
authors.lastname: Bontenbal
authors.forename: Peter C
authors.initials: PC
authors.lastname: Levendag