Skip to main content

Advertisement

SpringerLink
Log in

Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma

  • Review Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297–306.

    Article  CAS  PubMed  Google Scholar 

  2. Zivaljevic V, Slijepcevic N, Paunovic I, Diklic A, Kalezic A, Marinkovic J, et al. Risk factors for anaplastic thyroid cancer. Int J Endocrinol. 2014;2014:815070.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Gómez Sáez JM, Jiménez-Fonseca P, Santamaría Sandi J, Capdevila Castillón J, Navarro González E, et al. Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma. Endocrinol Nutr. 2015;62:e15–22.

    Article  PubMed  Google Scholar 

  4. Ain KB. Anaplastic thyroid carcinoma: behavior, biology, and therapeutic approaches. Thyroid. 1998;8:715–26.

    Article  CAS  PubMed  Google Scholar 

  5. Besic N, Gazic B. Sites of metastases of anaplastic thyroid carcinoma: autopsy findings in 45 cases from a single institution. Thyroid. 2013;23:909–13.

    Article  Google Scholar 

  6. Gómez Sáez JM. Perspectivas actuales en el carcinoma anaplásico de tiroides. In: Gómez Sáez JM, editor. Cáncer de Tiroides: Presente y Futuro. Barcelona: Elsevier; 2014. p. 273–86.

    Google Scholar 

  7. Konturek A, Barczynski M, Stopa M, Nowak W. Trends in prevalence of thyroid cancer over three decades: a retrospective cohort study of 17,526 surgical patients. World J Surg. 2016;40(3):538–44.

    Article  PubMed  Google Scholar 

  8. Haddad RI, Lydiatt WM, Ball DW, Busaidy NL, Byrd D, Callender G, et al. Anaplastic thyroid carcinoma, version 2.2015. J Natl Compr Cancer Netw. 2015;13:1140–50.

    CAS  Google Scholar 

  9. Sera N, Ashizawa K, Ando T, Ide A, Abe Y, Usa T, et al. Anaplastic changes associated with p53 gene mutation in differentiated thyroid carcinoma after insufficient radioactive iodine (131I) therapy. Thyroid. 2000;10:975–9.

    Article  CAS  PubMed  Google Scholar 

  10. Liu D, Xing M. Potent inhibition of thyroid cancer cells by the MEK inhibitor PD 0325901 and its potentiation by suppression of the PI3K and NF-kappaB pathways. Thyroid. 2008;18:853–64.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nikiforova MN, Nikiforov YE. Molecular diagnostics and predictors in thyroid cancer. Thyroid. 2009;19:1351–61.

    Article  CAS  PubMed  Google Scholar 

  12. Valeria C, Giovanni Z, Giuseppe P, Pierina P, Angela C, Vito R, et al. Multiple pluripotent stem cell markers in human anaplastic thyroid cancer: the putative upstream role of SOX2. Thyroid. 2012;7:15–26.

    Google Scholar 

  13. Griffith OL, Melck A, Montero-Conde C, Martín-Campos JM, Lerma E, Gimenez G, et al. Meta-analysis and meta-review of thyroid cancer gene expression profiling studies identifies important diagnostic biomarkers. J Clin Oncol. 2006;24:5043–51.

    Article  CAS  PubMed  Google Scholar 

  14. Onda M, Emi M, Yoshida A, Miyamoto S, Akaishi J, Asaka S, et al. Comprehensive gene expression profiling of anaplastic thyroid cancers with cDNA microarray of 25344 genes. Endocr Relat Cancer. 2004;11:843–54.

    Article  CAS  PubMed  Google Scholar 

  15. Montero-Conde C, Martín-Campos JM, Lerma E, Giménez G, Martínez-Guitarte JL, Combalía N, et al. Molecular profiling related to poor prognosis in thyroid carcinoma. Combining gene expression data and biological information. Oncogene. 2008;2:1554–61.

    Article  Google Scholar 

  16. Fuziwara CS, Kimura ET. MicroRNA deregulation in anaplastic thyroid cancer biology. Int J Endocrinol. 2014;2014:1–8.

    Article  Google Scholar 

  17. Reeb AN, Li W, Sewell W, Marlow LA, Tun HW, Smallridge RC, et al. S100A8 is a novel therapeutic target for anaplastic thyroid carcinoma. J Clin Endocrinol Metab. 2015;100:E232–42.

    Article  CAS  PubMed  Google Scholar 

  18. Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res. 2015;18(8):8.

    Article  Google Scholar 

  19. Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, for the American Thyroid Association, et al. Anaplastic thyroid cancer guidelines taskforce American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012;22:1004–139.

    Article  Google Scholar 

  20. Bogsrud TV, Karantanis D, Nathan MA, Mullan VP, Wiseman GA, Kasperbauer JL, et al. 18F-FDG PET in the management of patients with anaplastic thyroid carcinoma. Thyroid. 2008;18:713–7.

    Article  CAS  PubMed  Google Scholar 

  21. Smallridge RC. Approach to the patient with anaplastic thyroid carcinoma. J Clin Endocrinol Metab. 2012;97:2566–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Treglia G, Annunziata S, Muoio B, Salvatori M, Ceriani L, Giovanella L. The role of fluorine-18-fluorodeoxyglucose positron emission tomography in aggressive histological subtypes of thyroid cancer: an overview. Int J Endocrinol. 2013;2013:856189.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol. 2007;31:1256–64.

    Article  PubMed  Google Scholar 

  24. Burman KD. Is poorly differentiated thyroid cancer poorly characterized? J Clin Endocrinol Metab. 2014;99:1167–9.

    Article  CAS  PubMed  Google Scholar 

  25. Akaishi J, Sugino K, Kitagawa W, Nagahama M, Kameyama K, Shimizu K, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid. 2011;21:1183–9.

    Article  PubMed  Google Scholar 

  26. Sugitani I, Miyauchi A, Sugino K, Okamoto T, Yoshida A, Suzuki S. Prognostic factors and treatment outcomes for anaplastic thyroid carcinoma: ATC Research Consortium of Japan cohort study of 677 patients. World J Surg. 2012;36:1247–54.

    Article  PubMed  Google Scholar 

  27. Wein RO, Weber RS. Anaplastic thyroid carcinoma: palliation or treatment? Curr Opin Otolaryngol Head Neck Surg. 2011;19:113–8.

    Article  PubMed  Google Scholar 

  28. Keutgen XM, Sadowski SM, Kebebew E. Management of anaplastic thyroid cancer. Gland Surg. 2015;4:44–51.

    PubMed  PubMed Central  Google Scholar 

  29. Chiacchio S, Lorenzoni A, Boni G, Rubello D, Elisei R, Mariani G. Anaplastic thyroid cancer: prevalence, diagnosis and treatment. Minerva Endocrinol. 2008;33:341–57.

    CAS  PubMed  Google Scholar 

  30. Pudney D, Lau H, Ruether JD, Falck V. Clinical experience of the multimodality management of anaplastic thyroid cancer and literature review. Thyroid. 2007;17:1243–50.

    Article  PubMed  Google Scholar 

  31. Goffreddo P, Thomas SM, Adam MA, Sosa JA, Roman SA. Impact of timeliness of resection and thyroidectomy margin status on survival for patients with anaplastic thyroid cancer: an analysis of 335 cases. Ann Surg Oncol. 2015;22:4166–74.

    Article  Google Scholar 

  32. Sherman EJ, Lim SH, Ho AL, Ghossein RA, Fury MG, Shaha AR, et al. Concurrent doxorubicin and radiotherapy for anaplastic thyroid cancer: a critical re-evaluation including uniform pathologic review. Radiother Oncol. 2011;101:425–30.

    Article  CAS  PubMed  Google Scholar 

  33. Wang Y, Tsang R, Asa S, Dickson B, Arenovich T, Brierley J. Clinical outcome of anaplastic thyroid carcinoma treated with radiotherapy of once- and twice-daily fractionation regimens. Cancer. 2006;107:1786–92.

    Article  PubMed  Google Scholar 

  34. He X, Li D, Hu C, Wang Z, Ying H, Wu Y. Outcome after intensity modulated radiotherapy for anaplastic thyroid carcinoma. BMC Cancer. 2014;14:235.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bhatia A, Rao A, Ang KK, Garden AS, Morrison WH, Rosenthal DI, et al. Anaplastic thyroid cancer: clinical outcomes with conformal radiotherapy. Head Neck. 2010;32:829–36.

    PubMed  Google Scholar 

  36. Sun XS, Sun SR, Guevara N, Fakhry N, Marcy PY, Lassalle S, et al. Chemoradiation in anaplastic thyroid carcinomas. Crit Rev Oncol Hematol. 2013;86:290–301.

    Article  CAS  PubMed  Google Scholar 

  37. Heron DE, Karimpour S, Grigsby PW. Anaplastic thyroid carcinoma: comparison of conventional radiotherapy and hyperfractionation chemoradiotherapy in two groups. Am J Clin Oncol. 2002;25:442–6.

    Article  PubMed  Google Scholar 

  38. Higashiyama T, Ito Y, Hirokawa M, Fukushima M, Uruno T, Miya A, et al. Induction chemotherapy with weekly paclitaxel administration for anaplastic thyroid carcinoma. Thyroid. 2010;20:7–14.

    Article  CAS  PubMed  Google Scholar 

  39. Sosa JA, Balkissoon J, Lu SP, Langecker P, Elisei R, Jarzab B, et al. Thyroidectomy followed by fosbretabulin (CA4P) combination regimen appears to suggest improvement in patient survival in anaplastic thyroid cancer. Surgery. 2012;152:1078–87.

    Article  PubMed  Google Scholar 

  40. Savvides P, Nagaiah G, Lavertu P, Fu P, Wright JJ, Chapman R, et al. Phase II trial of sorafenib in patients with advanced anaplastic carcinoma of the thyroid. Thyroid. 2013;23:600–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Thomas L, Lai SY, Dong W, Feng L, Dadu R, Regone RM, et al. Sorafenib in metastatic thyroid cancer: a systematic review. Oncologist. 2014;19:251–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014;384:319–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Cohen EE, Rosen LS, Vokes EE, Kies MS, Forastiere AA, Worden FP, et al. Axitinib is an active treatment for all histologic subtypes of advanced thyroid cancer: results from a phase II study. J Clin Oncol. 2008;26:4708–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Pennell NA, Daniels GH, Haddad RI, Ross DS, Evans T, Wirth LJ, et al. A phase II study of gefitinib in patients with advanced thyroid cancer. Thyroid. 2008;18:317–23.

    Article  CAS  PubMed  Google Scholar 

  45. Ha HT, Lee JS, Urba S, Koenig RJ, Sisson J, Giordano T, et al. A phase II study of imatinib in patients with advanced anaplastic thyroid cancer. Thyroid. 2010;20:975–80.

    Article  CAS  PubMed  Google Scholar 

  46. Grande E, Capdevila J, Díez JJ, Longo F, Carrato A. A significant response to sunitinib in a patient with anaplastic thyroid carcinoma. J Res Med Sci. 2013;18:623–5.

    PubMed  PubMed Central  Google Scholar 

  47. Mooney CJ, Nagaiah G, Fu P, Wasman JK, Cooney MM, Savvides PS, et al. Phase II trial of fosbretabulin in advanced anaplastic thyroid carcinoma and correlation of baseline serum-soluble intracellular adhesion molecule-1 with outcome. Thyroid. 2009;19:233–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ain KB, Egorin MJ, DeSimone PA. Treatment of anaplastic thyroid carcinoma with paclitaxel: phase 2 trial using ninety-six-hour infusion. Collaborative Anaplastic Thyroid Cancer Health Intervention Trials (CATCHIT) Group. Thyroid. 2000;10:587–94.

    Article  CAS  PubMed  Google Scholar 

  49. Smallridge RC, Copland JA, Brose MS, Wadsworth JT, Houvras Y, Menefee ME, et al. Efatutazone, an oral PPAR-γ agonist, in combination with paclitaxel in anaplastic thyroid cancer: results of a multicentre phase 1 trial. J Clin Endocrinol Metab. 2013;98:2392–400.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Isham CR, Bossou AR, Negron V, Fisher KE, Kumar R, Marlow L, et al. Pazopanib enhances paclitaxel-induced mitotic catastrophe in anaplastic thyroid cancer. Sci Transl Med. 2013;5:166ra3.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Sosa JA, Elisei R, Jarzab B, Balkissoon J, Lu SP, Bal C, et al. Randomized safety and efficacy study of fosbretabulin with paclitaxel/carboplatin against anaplastic thyroid carcinoma. Thyroid. 2014;24:232–40.

    Article  CAS  PubMed  Google Scholar 

  52. Ongoing Clinical Trials. http://clinicaltrials.gov/ct2/results?term=thyroid+cancer.

  53. Wagle N, Grabiner BC, Van Allen EM, Amin-Mansour A, Taylor-Weiner A, Rosenberg M, et al. Response and acquired resistance to everolimus in anaplastic thyroid cancer. N Engl J Med. 2014;371:1426–33.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Marotta V, Sciammarella C, Vitale M, Colao A, Faggiano A. The evolving field of kinase inhibitors in thyroid cancer. Crit Rev Oncol Hematol. 2015;93:60–73.

    Article  CAS  PubMed  Google Scholar 

  55. Shinohara S, Kikuchi M, Naito Y, Fujiwara K, Hori S, Tona Y, et al. Successful treatment of locally advanced anaplastic thyroid carcinoma by chemotherapy and hyperfractionated radiotherapy. Auris Nasus Larynx. 2009;36:729–32.

    Article  PubMed  Google Scholar 

  56. Noguchi H, Yamashita H, Murakami T, Hirai K, Noguchi Y, Maruta J, et al. Successful treatment of anaplastic thyroid carcinoma with a combination of oral valproic acid, chemotherapy, radiation and surgery. Endocr J. 2009;56:245–9.

    Article  PubMed  Google Scholar 

  57. Fury MG, Solit DB, Su YB, Rosen N, Sirotnak FM, Smith RP, et al. A phase I trial of intermittent high-dose gefitinib and fixed-dose docetaxel in patients with advanced solid tumors. Cancer Chemother Pharmacol. 2007;59:467–75.

    Article  CAS  PubMed  Google Scholar 

  58. Hogan T, Jing Jie Yu, Williams HJ, Altaha R, Xiaobing Liang, Qi He. Oncocytic, focally anaplastic, thyroid cancer responding to erlotinib. J Oncol Pharm Pract. 2009;15:111–7.

    Article  CAS  PubMed  Google Scholar 

  59. Rosove MH, Peddi PF, Glaspy JA. BRAF V600E Inhibition in anaplastic thyroid cancer. N Engl J Med. 2013;368:684–5.

    Article  CAS  PubMed  Google Scholar 

  60. Lee YJ, Chung JK, Shin JH, Kang JH, Jeong JM, Lee DS, et al. In vitro and in vivo properties of a human anaplastic thyroid carcinoma cell line transfected with the sodium iodide symporter gene. Thyroid. 2004;14:889–95.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The Board of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology (SEOM) staff whose support made this review possible.

Conflict of interest

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Medical Oncology Service, Hospital Universitario Central de Asturias, Avenida de Roma sn, 33011, Oviedo, Spain

    P. Jiménez-Fonseca

  2. CIBERDEM, Endocrinology and Nutrition Service, Hospital Universitario de Bellvitge, Barcelona, Spain

    J. M. Gómez Saez

  3. Endocrinology and Nutrition Service, Hospital Universitario de Cruces, Vizcaya, Spain

    J. Santamaria Sandi

  4. Medical Oncology Service, Hospital Universitario de la Vall d’Hebron, Barcelona, Spain

    J. Capdevila

  5. Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain

    E. Navarro Gonzalez

  6. Endocrinology and Nutrition Service, Hospital Universitario de la Vall d’Hebron, Barcelona, Spain

    C. Zafon Llopis

  7. Medical Oncology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    T. Ramón y Cajal Asensio

  8. Endocrinology and Nutrition Service, Hospital Universitario de Móstoles, Madrid, Spain

    G. Riesco-Eizaguirre

  9. Medical Oncology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain

    E. Grande

  10. Endocrinology and Nutrition Service, Clínica Universidad de Navarra, Pamplona, Spain

    J. C. Galofré

Authors
  1. P. Jiménez-Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. M. Gómez Saez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Santamaria Sandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Capdevila
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Navarro Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Zafon Llopis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Ramón y Cajal Asensio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Riesco-Eizaguirre
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. C. Galofré
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Jiménez-Fonseca.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiménez-Fonseca, P., Gómez Saez, J.M., Santamaria Sandi, J. et al. Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma. Clin Transl Oncol 19, 12–20 (2017). https://doi.org/10.1007/s12094-016-1506-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-016-1506-0

Keywords

Search

Navigation