title: Early surgery and survival of patients with anaplastic thyroid carcinoma: analysis of a case series referred to a single institution between 1999 and 2012.
abstract: BACKGROUND
  Extensive resection of the tumor has been associated with better survival of anaplastic thyroid carcinoma (ATC) patients. However, surgery is not the rule for ATC patients with distant metastases at the time of diagnosis (stage IV-C), regardless of tumor resectability. The aim of this work was to explore the potential role of surgery in ATC patients, including those in stage IV-C.
  
  
  METHODS
  We considered all the consecutive ATC patients referred to our institution from June 1999 to July 2012. Patients with stage IV-A incidentally discovered ATC were excluded because of their better prognosis. All patients eligible for surgery at the time of diagnosis were first operated with the intent to obtain a macroscopically complete resection (R0, R1), or a R2 resection with minimal macroscopical residual tumor. These operations were defined as "maximal debulking," whereas operations that did not achieve this goal were defined as "partial debulking." After surgery, almost all patients received adjuvant chemotherapy, associated to radiotherapy in more than 50% of patients.
  
  
  RESULTS
  There were 55 eligible patients (34 women; median age 73.15 years). Thirty-one patients had distant metastases (stage IV-C). The median overall survival was 5.55 months [CI 4.94-6.60], with no difference according to stage. "Maximal debulking" was obtained in 70.73% of operated patients as a first modality and resulted associated with better survival than "partial debulking" (6.57 months [CI 5.52-12.09] vs. 3.25 months [CI 0.66-4.80]), without any difference between stage IV-B and IV-C patients. Furthermore, 21% of patients submitted to "maximal debulking" died secondary to local progression of the tumor, whereas this was the case for 69% of patients treated with "partial debulking" or not operated at all.
  
  
  CONCLUSIONS
  Early "maximal debulking," followed by adjuvant therapy, can improve the survival and ameliorate the quality of residual life preventing the risk of suffocation. This effect is also observed in patients with distant metastasis at diagnosis and treated with this approach: they have an outcome similar to that observed in stage IV-B patients. We thus suggest that surgery may be considered in the management of all ATC patients, and should not be restricted a priori to stages IV-A and IV-B.
authors.affiliation: 1 Department of Oncology, AOU Città della Salute e della Scienza di Torino , Turin, Italy .
authors.forename: Enrico
authors.initials: E
authors.lastname: Brignardello
authors.forename: Nicola
authors.initials: N
authors.lastname: Palestini
authors.forename: Francesco
authors.initials: F
authors.lastname: Felicetti
authors.forename: Anna
authors.initials: A
authors.lastname: Castiglione
authors.forename: Alessandro
authors.initials: A
authors.lastname: Piovesan
authors.forename: Marco
authors.initials: M
authors.lastname: Gallo
authors.forename: Milena
authors.initials: M
authors.lastname: Freddi
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.forename: Guido
authors.initials: G
authors.lastname: Gasparri
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Emanuela
authors.initials: E
authors.lastname: Arvat
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boccuzzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D065646:Thyroid Carcinoma, Anaplastic / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome