Should Surgery be Performed in Patient with Marginal Resectable Anaplastic Thyroid Cancer?

Abstract

Background: Anaplastic thyroid cancer (ATC) is rare but nearly lethal thyroid carcinoma. There is a dilemma on whether surgery or patient directed palliative care on patient with marginal resectable tumors. We aim to study the prognostic factor and treatment outcome in patients with extra-thyroidal extensions and lymph node metastasis. Methods: Over 40 years, patients with complete records diagnosed with ATC with extrathyroidal extension or presence of lymph node metastasis were recruited. Medical records were respectively reviewed. Impact on surgery and other treatment modality and other clinicopathological factor on survival were evaluated. Results: Forty three patients (72.1% female) with median age of 72 were included in the study. 34 (79.1%) patients had extra-thyroidal extension, while 21 (48.8%) had lymph node metastasis. Median overall survival was 14.6 weeks. Younger than 70 (p=0.003), patient treated with surgery (p=0.018) or radiotherapy (p<0.001) were the independent predictive factor of longer overall survival. 28 (63.1%) patients underwent operation, while 20 (46.5%) achieved macroscopic clearance (R0/R1) and 8 (18.6%) had gross residual disease during operation (R2). Patient undergoing operation have a longer survival (19.1 vs 5.4 weeks, p=0.001). While debulking surgery (R2) provided a survival benefit for patients with stage IVb disease. (14.7 vs 5.4 weeks, p= 0.035) Conclusions: Debulking surgery followed by radiotherapy could be considered for young patients with marginal resectable ATC. It prolongs survival and palliative patients symptoms.