RT for anaplastic thyroid carcinoma

[Kroll2013]

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Dear colleagues,
I have an 85 yo, very gd PS that has non-metastatic thyroid anaplastic carcinoma, that has undergone debulking surgery and tracheostomy. He was referred for RT.
The tumor board at his institution refused to do RT because in their experience, all pts progressed during the treatment.

The pt was referred to me for second opinion.

What do you recommend ?
Tx


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[xrthopeful]

Would recommend putting the patient on the current national Anaplastic Thyroid protocol or treating like they were on protocol (at least radiation wise)


https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0912

 

[Neuronix]

Treated a few of these in residency... There's no right answer, but even just the abstract of this paper sums it up:

http://www.ncbi.nlm.nih.gov/pubmed/23218594

85 year old is gonna have a hard time with concurrent, especially the concurrent adria and/or taxane based regimens that seem best for these.

If we're talking definitive intent... I would not treat per 0912 without chemo. IMO, 66 Gy in conventional fractionation is too wimpy for this. That's how you'll see progression through the treatment. With chemo, 66 Gy is probably ok with the chemo to help keep down repopulation, though I think a patient this age will have serious problems tolerating it. Without chemo, best option is probably 1.2 Gy BID to 81.2 or something similar. Could also consider 2 Gy per day in 6 fx per week.

Could make a good argument to do something palliative. I've never tried a quad shot on one of these, though I'm afraid it would laugh at us...

I would be interested in someone's opinion who has more experience with anaplastic thyroid cancer. They're not very common.

 

[Palex80]

48/3 may be a good option.
Quick and manageable in terms of side effects.

The dose is irrelevant in my opinion. All patients relapse either locally or distant first, you are merely shifting the site of recurrence from local to distant with increasing dose, probably offering no survival benefit. On the other hand higher doses will lead to higher toxicity and will destroy QoL in the last months this patient has to live. The same goes for concurrent RCT.

 

[thaddeus]

Would recommend putting the patient on the current national Anaplastic Thyroid protocol or treating like they were on protocol (at least radiation wise)


https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0912

We've had relatively young, healthy folks do horribly on this protocol in terms of acute toxicity leading to hospitalizations and QoL compromise. Would agree with RT alone essentially for palliation, but something more than quad shot....

 

[nkmiami]

In my experience, there is a difference between anaplastic thyroid that arises in the setting of transformation of longstanding pap/follicular vs de novo. De novo do much worse. IMRT is a must- I would skimp on PTV expansions into pharyngolarynx where you can.

 

[Cancerdancer]

Anecdotally have had similar pts (very elderly) who were driving a distance, pushing me to want to do hypofractionation given nihilism about 30+ fractions.
Treated a few 6 Gy x 5 ala MDACC melanoma schema. spread over two weeks. Sufficient local control until they passed from a non-asphyxiation death, which is sadly the goal here.
I wouldn't do chemoRT to 66 Gy w/ Adriamycin for 6 of their few remaining weeks of life in an 85 yo...