Endocrine Abstracts

Objective: The epithelial cancers of the thyroid include papillary, follicular, hurtle and anaplastic. These are divided into well, poorly differentiated thyroid cancer and undifferentiated (or anaplastic) thyroid cancer (ATC). ATC is uncommon and very agressive entity. It is responsible for 7, 5% of all thyroid cancers. The aim of our study is to discuss the clinical aspects and therapeutic modalities of ATC through our series with review of the literature.

Patients and Methods: This is a retrospective study that collected patients taken care of in our department for ATC over a period of 30 years.

Results: Our series included 8 patients, comprising 7 females and one male, with a mean age of 69 years. The main reason for consultation was a rapidly-growing basicervical anterior and/or lateral cervical mass in all cases. Compressive signs were present in 3 patients. The average consultation delay was 3 months. Physical examination revealed a goiter with an average size of 5 cm, with tenderness in 3 cases. Jugulodigastric lymphadenopathy was associated in 5 cases and supraclavicular in one case. Indirect laryngoscopy performed for all patients showed laryngeal palsy in two patients. Ultrasound was performed for 6 patients and revealed a multinodular goiter classified as EUTIRADS IV in 3 cases and EUTIRADS V in 3 cases. Cervico-thoracic computed tomography was performed in 3 patients due to the presence of compressive signs. Total thyroidectomy with bilateral mediastino-recurential curage was performed in 4 cases. Lateral dissection was carried out in 3 cases and deemed impossible in two cases due to adhesion of lymph nodes to the esophagus and trachea. The tumor was considered unresectable in 3 cases. External radiotherapy was indicated in 6 cases, combined with radioactive iodine therapy in 3 cases due to the association with papillary carcinoma. The average follow-up duration was 6 months.

Discussion/conclusion: Anaplastic thyroid cancer remains one of the most deadly diseases. According to literature, patients with ATC have a median survival of 5 months and less than 20% survive 1 year. Early tumor dissemination results in 20-50% of patients having distant metastases and 90% having adjacent tissue invasion on presentation. This highlights the necessity for effective combined therapy. Resectable disease may benefit from a multimodal (surgery, IMRT for loco regional control, and systemic therapy) approach. However, a majority of patients present with unresectable locoregional disease. Early palliative care involvement is inclusive of life-prolonging therapies. ATC management demands rapid and integrated multidisciplinary decision making.