Original contributionThe role of surgery in anaplastic thyroid cancer: A systematic review☆
Introduction
Anaplastic thyroid carcinoma (ATC) is a highly aggressive form of thyroid cancer, with a reported median survival rate of only 4 months. While multimodal therapy is frequently advocated, the precise role of surgery for patients with advanced disease is unclear. The approach to surgical management for patients with ATC varies across institutions and surgeons. Studies have drawn conflicting conclusions regarding aggressiveness of tumor resection in the presence of extrathyroidal extension. Some experts have concluded that patients undergoing radical resection with negative margins have no survival benefit over those with positive microscopic or macroscopic margins [1], [2], [3]. Other authors have shown that complete resection is a positive prognostic factor [4], [5], [6]. Likewise, in patients with tumors considered unresectable, the role of debulking or ultraradical surgery has been debated. We perform the first systematic review of the role of surgery in the management of ATC with the goal of developing a framework or algorithm for decision-making.
Section snippets
Methods
We aimed to identify all full-text, peer-reviewed publications pertaining to the treatment of ATC. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was used to identify and collate studies [1]. The searches were conducted in the Ovid MEDLINE, Cochrane Library and Google Scholar databases for studies published from December 2000 to July 1, 2016. The following search terms were used: anaplastic thyroid, treatment. Results were combined with the terms,
Results
89 articles underwent full review after screening 561 abstracts, and 40 publications met criteria for inclusion. The search strategy and flow diagram (Fig. 1) are presented using the PRISMA guidelines [7]. No relevant level 1, 2, or 3 studies were found. The results of the 40 studies are summarized in Table 1 [2], [3], [4], [5], [6], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35]
Discussion
ATC presents most commonly as a rapidly enlarging neck mass and is often diagnosed at an advanced stage with a poor prognosis. Invasion into mediastinal vessels or prevertebral fascia is broadly accepted as definitive criteria for unresectability, although this review demonstrates the differing perspectives on the definition of resectability. Radical extirpative surgery, requiring the sacrifice of speech and swallowing function, is of questionable benefit to the patient, even when clear margins
Conclusions
The improved survival seen with surgery and multimodal therapy for ATC may be explained by a reduced risk of dying from local progression of the tumor, which is the most rapidly fatal manifestation of ATC [11]. In certain patients, wide surgical resection followed by adjuvant therapy can improve OS, may ameliorate the subsequent QOL, and plays a role in palliation and decompression. However, the benefit of aggressive surgery is often of limited clinical significance in advanced cases and
References (48)
- et al.
Anaplastic thyroid carcinoma: a 50-year experience at a single institution
Surgery
(2001) - et al.
Combined treatment of anaplastic thyroid carcinoma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy
Int J Radiat Oncol Biol Phys
(2004) - et al.
Anaplastic thyroid carcinoma: aggressive radical resection and cervical reconstruction. A case report
Ann Chir
(2006) - et al.
Anaplastic thyroid cancer in young patients: a contemporary review
Am J Otolaryngol
(2013) - et al.
Successful treatment of locally advanced anaplastic thyroid carcinoma by chemotherapy and hyperfractionated radiotherapy
Auris Nasus Larynx
(2009) - et al.
Survival in anaplastic thyroid cancer in relation to pre-existing goiter: a population-based study
Am J Surg
(2015) - et al.
The important role of operations in the management of anaplastic thyroid carcinoma
Surgery
(2002) - et al.
Multimodality treatment for anaplastic thyroid carcinoma–treatment outcome in 75 patients
Radiother Oncol
(2009) - et al.
Impact of timeliness of resection and thyroidectomy margin status on survival for patients with anaplastic thyroid cancer: an analysis of 335 cases
Ann Surg Oncol
(2015) - et al.
Anaplastic carcinoma of the thyroid gland: treatment and outcome over 13 years at one institution
J Surg Oncol
(2012)
Aggressive surgical resection of anaplastic thyroid carcinoma may provide long-term survival in selected patients
Otolaryngol Head Neck Surg
Anaplastic thyroid carcinoma: a 25-year single-institution experience
Ann Surg Oncol
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement
Ann Intern Med
Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma
Thyroid
Anaplastic thyroid cancer: multimodal treatment results
Ecancermedicalscience
Anaplastic thyroid carcinoma: clinical outcome of 30 consecutive patients referred to a single institution in the past 5 years
Eur J Endocrinol
Early surgery and survival of patients with anaplastic thyroid carcinoma: analysis of a case series referred to a single institution between 1999 and 2012
Thyroid
A multimodality therapeutic approach in anaplastic thyroid carcinoma: study on 39 patients
J Endocrinol Invest
Anaplastic thyroid carcinoma: a therapeutic dilemma
Yonsei Med J
Results of combined treatment of anaplastic thyroid carcinoma (ATC)
BMC Cancer
Noninvasive anaplastic thyroid carcinoma: report of a case and literature review
Thyroid
Management of anaplastic thyroid carcinoma spread over the trachea with mediastinal extension
G Chir
Enhanced survival in locoregionally confined anaplastic thyroid carcinoma: a single-institution experience using aggressive multimodal therapy
Thyroid
Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival
Cancer
Cited by (35)
Anaplastic thyroid cancer: An update
2023, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :There is a limited role for debulking or incomplete surgery (R2) as this neither improves survival nor locoregional control. Stage of disease, for example stage IVA and select IVB, is an important factor that predicted overall success and survival benefit of surgery, as shown in a review of more than 40 studies [37]. Adjuvant therapy should be initiated within a few weeks after surgery, no matter the stage, as ATC may rapidly recur, whether local or distant, thereby increasing mortality.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. None of the authors have any conflicts of interest to declare.