Introduction: Anaplastic thyroid carcinoma, either by its low frequency, or by its poor prognosis, is still as a therapeutic challenge. One of the options available is the combined chemoradiation therapy, the basis of the following case.
Case report: Male patient, 76 years old, with a history of neck swelling for 4 months. The cervical ultrasound showed a nodule in the right lobe of the thyroid with 7 by 5 cm and the cytology revealed follicular tumor. Submitted to total thyroidectomy, the histopathology was of papillary thyroid carcinoma with anaplastic transformation. Given the fact that the thyroid resection was complete and that the patient had no pulmonary metastases, the patient started chemotherapy with doxorubicin (10 mg/kg) weekly, followed by hyperfracionated radiotherapy, 1.6 Gy, 2 times a day (with a four hour break), 3 times a week, for 6 weeks. By the fifth week of treatment, the patient had already evidence of pharyngoesophagitis and skin erythema, reactions that subsided 4 weeks after the completion of the treatment.
At six month follow up, there is no clinical, analytical or imagiological evidence of relapse.
Discussion: In this case, the hyperfracionated radiation resulted in increased survival. In our Institute, this treatment has been used in 4 other patients with complete remission longer than 5 years in 2 cases and inconclusive in other 2 (death by suicide and sudden death after treatment).
Although there are no randomized trials published, the likelihood of partial or even complete remission of the disease is still better than expected with other treatments.
25 - 29 Apr 2009
European Society of Endocrinology