title: The role of surgery in the treatment of thyroid anaplastic carcinoma in the elderly.
abstract: BACKGROUND
  Anaplastic thyroid carcinoma (ATC) is characterized by local invasiveness, risk of recurrence and very poor prognosis.
  
  
  METHODS
  We retrospectively analysed the multimodality treatment of ATC in 79 patients considering the impact of surgery on survival.
  
  
  RESULTS
  Patients were divided in two age groups A and B (cut-off 75 years) and in two size subgroups (cut-off 5 cm). Surgery was performed in 78.5% patients of group A and 32.4% of B (p < 0.05). Radiation respectively in 73.8% and 43.2% (p < 0.05). Tracheostomy and endoprosthesis were used in 45.2% and 16.6% in group A and in 43.2% and 35.1% in group B. The use of tracheostomy was significantly higher (p < 0.05) in larger tumours. In group B comparing operated and not operated patients significant difference in survival was observed for larger tumours (p = 0.043). In Kaplan Meir analysis significant difference in survival was observed comparing surgical and no surgical patients of all four subgroups. Surgery plus radiotherapy offered a significant better outcome in smaller tumours (p = 0.017). Considering the effect of the single treatment, compared to no treatment at all, survival is significantly improved by surgery for smaller and larger tumours respectively with 4.42 (p = 0.001) and with 3.5 months (p = 0.0001) and by radiotherapy respectively with 3.44 and with 3.28 months (p = 0.047 and p = 0.0001).
  
  
  CONCLUSIONS
  In elderly patients with ATC, although poor prognosis, surgery is still fundamental in the multimodality treatment with significant advantage in selected patients. Nevertheless most of elderly patients with large tumours are suitable only for palliative management.
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: apolis74@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: massimo.monacelli@mail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: robertalucchini@alice.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lucchini
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: triolaroberta@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Triola
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: c.claudia81@alice.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Conti
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: stefano_avenia@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Avenia
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: rondellif@hotmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: walterbugiantella@alice.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: ivanbarillaro@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Barillaro
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: alessandrosanguinetti@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D019736:Prostheses and Implants; D011878:Radiotherapy / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D065646:Thyroid Carcinoma, Anaplastic / Q000628:therapy*; D013964:Thyroid Neoplasms / Q000628:therapy*; D013965:Thyroidectomy; D014139:Tracheostomy; D016896:Treatment Outcome
keywords: Anaplastic carcinoma; Elderly patients; Prognosis; Surgery; Survival