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Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery

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Abstract

Anaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64 Gy) to the neck, followed by surgery 4–8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002–2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, with death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four were dependent on a tracheal cannula when they died. The best median survival, 19 months, was obtained in the 13 patients where both radiotherapy and surgery were possible as primary treatments. Only surgery came out as a prognostic factor for survival in multivariate analysis. Patients surviving more than 2 years were characterised by having surgery with R0 resection and no or small residual foci of ATC in the specimens. Stage 4C patients survived 3 months only.

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Authors and Affiliations

  1. Division of Cancer Medicine, Department of Oncology, Oslo University Hospital, Box 4953, 0424, Oslo, Norway

    Anne-Birgitte Jacobsen

  2. Division of Laboratory Medicine, Department of Pathology, Oslo University Hospital, Box 4953, 0424, Oslo, Norway

    Krystyna K. Grøholt & Eva Sigstad

  3. Division of Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Box 4953, 0424, Oslo, Norway

    Bianca Lorntzsen & Terje A. Osnes

  4. Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Box 4953, 0424, Oslo, Norway

    Ragnhild Sørum Falk

  5. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Box 4953, 0424, Oslo, Norway

    Bianca Lorntzsen & Terje A. Osnes

Authors
  1. Anne-Birgitte Jacobsen
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  2. Krystyna K. Grøholt
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  3. Bianca Lorntzsen
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  4. Terje A. Osnes
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  5. Ragnhild Sørum Falk
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  6. Eva Sigstad
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Corresponding author

Correspondence to Anne-Birgitte Jacobsen.

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Ethical approval

The study was approved by the Regional Ethical Committee and the hospital’s local authorities, and the patients are fully anonymized in the paper. Permission was given from the Regional Ethical Committee to omit informed consent from the patients, since most of them were dead at the time of data collection.

Conflict of interest

The authors report no conflicts of interest.

Funding

The research was done within the frames of Oslo University Hospital with no external grants.

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Jacobsen, AB., Grøholt, K.K., Lorntzsen, B. et al. Anaplastic thyroid cancer and hyperfractionated accelerated radiotherapy (HART) with and without surgery. Eur Arch Otorhinolaryngol 274, 4203–4209 (2017). https://doi.org/10.1007/s00405-017-4764-8

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  • DOI: https://doi.org/10.1007/s00405-017-4764-8

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