ETA2023 Poster Presentations Thyroid Cancer clinical 3 (9 abstracts)
A large series of patients with anaplastic thyroid cancer managed in a tertiary referral center
Elisa Minaldi 1 , Elena Sabini 1 , Alessandro Prete 1 , Laura Agate 1 , Valeria Bottici 1 , Sandra Brogioni 1 , Liborio Torregrossa 2 , Clara Ugolini 2 , Gabriele Materazzi 2 , Alessandro Ribechini 3 , Luca Bruschini 2 , Eleonora Molinaro 1 , Antonio Matrone 1 & Rossella Elisei 1
1University Hospital of Pisa, Endocrine Unit, Department of Clinical and Experimental Medicine, Pisa, Italy; 2University Hospital of Pisa, Department of Surgical, Medical and Molecular Pathology; 3University Hospital of Pisa, Endoscopic Thoracic Endoscopy Division
Objectives: Anaplastic thyroid cancer (ATC) is one of the deadliest cancers, with a median overall survival (OS) of 4 months and a disease-specific mortality of ˜100%. Although to date no effective treatment can cure the disease, some anecdotal cases achieved longer survival and very rarely the cure of the disease. Multimodal treatment with surgery, radiotherapy, multikinase inhibitors (MKI) could improve survival in ATC, particularly when surgery is not feasible.
Methods: We retrospectively evaluated 145 consecutive patients followed at the Endocrine Unit of the University Hospital of Pisa, with pathologically confirmed ATC having complete follow-up data, from 1972 to 2023. The aim was to characterize the clinical features of ATC and investigate the possible role of MKI in prolonging survival.
Results: Females (58.1%) and males (41.9%) were equally represented. The median age was 67 years (IQR 57-75; min-max 33-92). Stage at diagnosis was IVa in 17 (11.7%) patients, IVb in 23 (15.9%) and IVc in 105 (73.4%). The median OS was 4.02 months (IQR 1.97-7.16; min-max 0.13-240). Surgical treatment was feasible in 92 (63.4%) cases: total thyroidectomy with apparently R0 resection in 46 (50%) cases and only debulking in the other 50% of cases. At diagnosis, 69 (48.9%) patients had tracheal invasion, 40 (28.6%) had esophageal invasion and 7 (7.1%) had neck cutaneous infiltration. Some patients received also radiotherapy (n =66, 47.5%) and chemotherapy (n =53, 37.9%). MKI were administered in 35 (25.2%) patients: sorafenib in 18 (51.4%) and lenvatinib in 15 (42.9%). In 2 cases (5.7%) dabrafenib and trametinib were also used. Analyzing the potential utility of MKI treatments compared to conventional chemotherapies, an improvement in OS was observed with MKI in the first 2 years after diagnosis [HR 0.538; 95% CI 1.201-2.876; P = 0.005]. Unfortunately, this association was later lost. Three patients were considered long survivors (median follow-up: 56.77 months; min-max 22.08-131.52) and today are still alive. Two patients are in remission after surgery, chemotherapy, radiotherapy and in one of these also sorafenib treatment. The third patient underwent radiotherapy and is now on dabrafenib-trametinib, showing a partial response at the last evaluation.
Conclusions: In this large single-center series we confirmed that survival of ATC has not changed over the years, despite new and emerging treatments. However, MKI may be helpful in controlling disease progression, especially in the first 2 years after diagnosis. Although very rarely, some cases of ATC benefited from the treatments performed, up to having a longer survival.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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