Anaplastic Carcinoma Thyroid - A Review on the Management of this Aggressive Cancer

Anaplastic carcinoma thyroid is an aggressive malignancy with very poor survival rate. In this study, we reviewed the records of 34 patients with anaplastic carcinoma thyroid in our centre and we divided them into groups T4a, T4b, and T4c. The case records were reviewed for presentation, diagnosis, treatment and follow-up and we analysed the data using statistical methods. The median age group was 65 years with 22 women and 12 men. There were 16 patients (47%) with a history of thyroid swelling of more than 2 years duration. Of these 16 patients 6 were found to be in T4a group. There were 6 patients in T4a, 14 each in T4b and T4c. All the patients in T4a group were operated and completed multimodal management. The group with T4a had the best prognosis with a mean survival of 1 year. The patients with extracapsular disease (T4b) completed chemotherapy along with radiotherapy. These patients had a mean survival of 6 months. Only 2 patients in metastatic group completed the course of chemotherapy with radiotherapy. The other 12 patients died during the course of treatment due to respiratory failure. The mean survival in this group was a dismal 15 days. On univariate analysis metastatic disease, extracapsular disease, size more than 5 cm and involvement of lymph nodes were the reasons for incomplete treatment and hence markers of worst prognosis. There are 47% of the patients with prior history of thyroid swelling which gives us time to identify and manage thyroid swellings with propensity to undergo anaplastic transformation.