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Anaplastic Thyroid Carcinoma: A Therapeutic Dilemma
장항석,남기현,정웅윤,박정수 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.6
Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3,088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n= 10), 2.1 months, Group 2 (n=8); 3.6 months; Group 3 (n= 7), 3.0 months; Group 4 (n=14), 3.5 months, Group 5 (n= 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
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장항석,장호진,Hang-Seok Chang,Hojin Chang 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.2
Thyroid cancer is an indolent condition that usually presents as a limited disease in the neck. Invasion to vital organs is rarely observed; however, it can be a major cause of mortality, even in well-differentiated thyroid cancers. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngo-tracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled invasion to vital organs in the neck and mediastinum can cause significant morbidity and affect quality of life and survival. Limited involvement of the aero-digestive tract can be controlled by conservative surgical treatments such as shaving-off procedures, while radical resection and subsequent reconstructive procedures are the best choice for more serious cases. In planning the treatment, the risk-benefit ratio should be carefully evaluated to reduce the morbidity, as well as achieve maximal therapeutic effects. Postoperative adjuvant therapies have been the subject of controversy, but there is a general consensus, especially for high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external beam radiation therapy are unclear, but it should be considered in patients with microscopic residual disease. In conclusion, radical eradication of lesions followed by proper adjuvant therapy is the treatment of choice for locally advanced thyroid cancers.
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