Contemporary Management of Anaplastic Thyroid Cancer
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Head and Neck Cancer (CP Rodriguez, Section Editor)
Contemporary Management of Anaplastic Thyroid Cancer Wilson Alobuia, MD1 Andrea Gillis, MD2 Electron Kebebew, MD1,* Address *,1 Division of General Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3591, Stanford, CA, 94305, USA Email: [email protected] 2 Division of General Surgery, Department of Surgery, Albany Medical College, 43 New Scotland Avenue, MC – 61, Albany, NY, 12208, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Head and Neck Cancer Keywords Anaplastic thyroid I Cancer I Thyroid cancer I Surgery I Chemotherapy I Targeted therapy I Radiation Abbreviations ATC Anaplastic thyroid cancer DTC Differentiated thyroid cancer PDTC Poorly differentiated thyroid _ _ cancer
Opinion statement Anaplastic thyroid cancer (ATC) is a rare but very aggressive form of undifferentiated thyroid cancer. Due to its rapid rate of progression and invasive nature, ATC poses significant risks of morbidity and mortality. The cornerstone in the management of ATC remains a prompt diagnosis of the disease and timely management of complications depending on the stage of disease. Surgery continues to offer a higher chance of a cure, although not all patients are candidates for surgical management. Patients with advanced disease may be considered for palliative surgery to reduce morbidity and complications from advanced disease. With the advent of new molecular testing and improved methods of diagnosis, novel therapeutic targets have been identified. Systemic therapy (chemotherapy and radiation therapy) as well as novel immunotherapy have shown some promise in patients with targetable genetic mutations. Patients should therefore have molecular testing of their tumor—if it is unresectable—and be tested for mutations that are targetable. Mutation-targeted therapy may be effective and may result in a significant response to allow surgical intervention for exceptional responders. Overall, patients who receive all three modalities of therapy (surgery, chemotherapy, and radiation therapy) have the highest overall survival.
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Curr. Treat. Options in Oncol.
(2020) 21:78
Introduction Anaplastic thyroid cancer (ATC) is a rare form of undifferentiated thyroid cancer representing approximately 2% of all thyroid cancers, but accounting for a majority of all thyroid cancer deaths [1]. The median overall survival of patients with ATC is approximately 3– 6 months and less than 20% of affected patients are alive 1 year after diagnosis; thus, ATC is one of the most aggressive malignancies in humans [2, 3]. Approximately 30–40% of patients present with locoregional metastases and/or vocal cord paralysis, and 70% of patients have direct invasion of local tissue including the trachea, muscle, esophagus, and larynx [4]. Distant metastasis at
the time of presentation is common and can involve multiple sites including the lungs (50–80%), bone, skin, and brain (6–1
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