The important role of operations in the management of anaplastic thyroid carcinoma

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Background.Anaplastic thyroid carcinoma is a rare and highly lethal neoplasm. We investigated whether operations have an impact on the survival of patients who have anaplastic carcinoma without distant metastasis.Methods.Between 1989 and 1999, 40 consecutive patients with anaplastic carcinoma, without distant metastasis at the time of presentation or during local treatment, were reviewed. The cumulative survival rates and 1-year survival rates were compared.Results.Eleven patients had a small focus of anaplastic carcinoma in a differentiated carcinoma, and 29 patients had ordinary anaplastic thyroid carcinoma. Surgical debulking was performed in 26 patients. Radiotherapy was used for 31 patients and chemotherapy for 19 patients. The 1-year survival rates of the patients with incidental anaplastic carcinoma, ordinary anaplastic carcinoma who underwent operations, and ordinary anaplastic carcinoma who did not undergo operations were 73%, 60%, and 21%, respectively. A significantly higher cumulative survival rate was observed in patients with incidental anaplastic carcinoma than in those with ordinary anaplastic carcinoma. A significantly better outcome was obtained by surgical debulking of ordinary anaplastic carcinoma.Conclusions.Patients with incidental anaplastic carcinoma tended to have a good outcome, but some had a poor prognosis. Surgical debulking improved the outcome of patients with ordinary anaplastic carcinoma. (Surgery 2002;131:245-8.)

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