title: Anaplastic thyroid cancer: multimodal treatment results.
abstract: BACKGROUND
  Anaplastic thyroid cancer is a rare and lethal disease. It accounts for 1-2% of thyroid malignancies, but specific mortality is higher than 90%. It is an aggressive locoregional disease with a high metastatic capacity. There is no agreement with regards to the best treatment. We analysed the results of treatment in a mestizo population treated in the National Cancer Institute (Mexico).
  
  
  METHODS
  We reviewed 1,581 files of thyroid carcinomas; of these, 29 (1.83%) had anaplastic thyroid carcinoma. Demographic variables, clinical manifestations, tumour characteristics, and treatments were analysed.
  
  
  RESULTS
  The median age was 64.5 ± 13.2 years. Females were more affected (female/male ratio: 2.6:1); 21 cases occurred in women (72.4%), and eight in males (27.6%). The most common manifestations were neck enlargement (93.10%) and hoarseness (71.31%). The median tumour size was 8 cm (range: 4-20 cm). The percentage of cases which presented in clinical stage IVA was 10.3%, with 62.1% presenting in clinical stage IVb and 27.6% presenting in clinical stage VIc. Complete resection (R0) (p = 0.05), radiation doses of higher than 33.1 Gy (p = 0.04), and multimodal therapy were associated with better survival. Surgery plus radiotherapy with or without systemic treatment (p = 0.006). The median overall survival was 119 days (IC 95%, 36.3-201.6). Six-month, one-year and two-year survival was 37.9%, 21% and 13%, respectively.
  
  
  CONCLUSIONS
  Complete surgical resection is associated with better survival but is very difficult to achieve due to aggressive biological behaviour. Multimodal therapy is associated with better survival and a better quality of life. There is a need for more effective systemic treatments as extensive surgical resections have little overall benefit in highly invasive and metastatic disease.
authors.affiliation: Department of Head and Neck, Instituto Nacional de Cancerología, Mexico.
authors.forename: Zaki Antonio Taissoun
authors.initials: ZA
authors.lastname: Aslan
authors.affiliation: Department of Head and Neck, Instituto Nacional de Cancerología, Mexico.
authors.forename: Martín
authors.initials: M
authors.lastname: Granados-García
authors.affiliation: Department of Head and Neck, Instituto Nacional de Cancerología, Mexico.
authors.forename: Kuauhyama
authors.initials: K
authors.lastname: Luna-Ortiz
authors.affiliation: Department of Head and Neck, Instituto Nacional de Cancerología, Mexico.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Guerrero-Huerta
authors.affiliation: Department of Head and Neck, Instituto Nacional de Cancerología, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gómez-Pedraza
authors.affiliation: Surgical Subdivision, Instituto Nacional de Cancerología, Mexico.
authors.forename: Silvio A
authors.initials: SA
authors.lastname: Namendys-Silva
authors.affiliation: Department of Pathology, Instituto Nacional de Cancerología, Mexico.
authors.forename: Abelardo
authors.initials: A
authors.lastname: Meneses-García
authors.affiliation: Department of Surgery, Universidad Militar UMNG de Colombia, Bogotá DC.
authors.forename: Juliana María
authors.initials: JM
authors.lastname: Ordoñez-Mosquera
keywords: anaplastic thyroid cancer; multimodal treatment; prognoses; thyroid cancer
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