Chemotherapy of thyroid carcinoma

On the basis of 8 patients of our own and a survey of the literature, the present state of chemotherapy of thyroid carcinoma is discussed. Chemotherapy is only indicated in cases of progressing disease after exhaustion of all conventional therapies. Only in cases of undifferentiated giant- or spindle-cell thyroid carcinomas can chemotherapy following conventional treatment be approved right from the beginning. The three most widely applied cytostatics are adriamycin, bleomycin and cis-platinum, and it seems that adriamycin monotherapy, is superior to all other therapies, even combinations, except probably for the undifferentiated thyroid carcinoma. In addition to the patient's general condition, a sufficiently high single dose of adriamycin, which should be increased in case of nonresponse, appears to be essential for the therapeutical effect. Due to its low toxicity, especially cardiotoxicity, 4'-epi-adriamycin, which, while being almost as effective, can be applied at higher doses and over longer periods, seems to be promising. Approximately 1/3 of thyroid carcinomas respond to adriamycin monotherapy, the response rate probably being highest for medullary types and lowest for undifferentiated thyroid carcinomas. The highest response is observed in the case of pulmonary metastases, followed by bone metastases and local tumor growth. If thyroid carcinomas respond to chemotherapy--even by no-change behavior only--a prolongation of median survival rates from 3-5 months (nonresponders) to 15-20 months (responders) can be achieved.