scholarly journals Anaplastic thyroid cancer: molecular pathogenesis and emerging therapies

2009 ◽  
Vol 16 (1) ◽  
pp. 17-44 ◽  
Author(s):  
Robert C Smallridge ◽  
Laura A Marlow ◽  
John A Copland
Keyword(s):  
Clinical Trials ◽  
Thyroid Cancer ◽  
Chromosomal Abnormalities ◽  
Anaplastic Thyroid Cancer ◽  
Molecular Pathogenesis ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Rare Malignancy ◽  
Differentiated Thyroid Cancers

Anaplastic thyroid cancer (ATC) is a rare malignancy. While external beam radiation therapy has improved locoregional control, the median survival of ∼ 4 months has not changed in more than half a century due to uncontrolled systemic metastases. The objective of this study was to review the literature in order to identify potential new strategies for treating this highly lethal cancer. PubMed searches were the principal source of articles reviewed. The molecular pathogenesis of ATC includes mutations in BRAF, RAS, catenin (cadherin-associated protein), beta 1, PIK3CA, TP53, AXIN1, PTEN, and APC genes, and chromosomal abnormalities are common. Several microarray studies have identified genes and pathways preferentially affected, and dysregulated microRNA profiles differ from differentiated thyroid cancers. Numerous proteins involving transcription factors, signaling pathways, mitosis, proliferation, cell cycle, apoptosis, adhesion, migration, epigenetics, and protein degradation are affected. A variety of agents have been successful in controlling ATC cell growth both in vitro and in nude mice xenografts. While many of these new compounds are in cancer clinical trials, there are few studies being conducted in ATC. With the recent increased knowledge of the many critical genes and proteins affected in ATC, and the extensive array of targeted therapies being developed for cancer patients, there are new opportunities to design clinical trials based upon tumor molecular profiling and preclinical studies of potentially synergistic combinatorial novel therapies.

scholarly journals SUN-LB77 Incidental Anaplastic Thyroid Carcinoma: An Uncommon Entity

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Preethi Padmanaban ◽  
Eric Nylen
Keyword(s):  
Thyroid Cancer ◽  
Adjuvant Therapy ◽  
Median Survival ◽  
Anaplastic Thyroid Cancer ◽  
Anaplastic Carcinoma ◽  
External Beam Radiation ◽  
Whole Body ◽  
American Thyroid Association ◽  
Beam Radiation ◽  
Disease Free

Abstract Background: Anaplastic thyroid cancer is an aggressive thyroid malignancy with a median survival of 3 to 9 months. It is rare and represents 2-5% of all thyroid tumors. Even more uncommonly in about 2%–6% of all ATC cases, it is identified as a small, incidental finding after surgical resection of a predominantly non-anaplastic tumor. Clinical Case: We report a case of 67 year old Caucasian male who presented with history of hoarseness of voice for one month. Fine needle aspiration biopsy of right dominant thyroid nodule revealed papillary thyroid cancer. Pre-operative imaging was negative for involvement of surrounding structures or distant metastasis. He underwent total thyroidectomy and final pathology revealed Anaplastic carcinoma arising in papillary carcinoma measuring 3.6cm in greatest dimension. Undifferentiated (Anaplastic) Carcinoma comprised approximately 5% of the tumor. Areas from anaplastic and papillary tumor were dissected separately. DNA separated from these two specimens were analyzed by PCR amplification and both were positive for BRAF mutation. External beam radiation and radioactive iodine therapy were administered after surgery. Given absence of invasion or metastasis adjuvant therapy was not initiated. His positron emission tomography, computed tomography imaging and whole-body scan has been negative for residual/ recurrent or metastatic disease. He remains disease free at 18 months after diagnosis. Discussion: Anaplastic thyroid cancer is a rare but highly aggressive tumor. In most cases it develops from a pre-existing well differentiated thyroid cancer. ATC incidence typically peaks at the 6-7th decade of life, predominantly in women. The median survival is between 3 to 9 months with less than 10% of patients alive 3 years after the time of diagnosis. Because of its aggressive behavior, the American Joint Committee on Cancer Staging Manual classifies all Anaplastic thyroid cancer Stage IV tumors. Surgery, chemotherapy and radiotherapy are the conventional therapeutic strategies performed in the attempt to improve survival. However, incidental anaplastic thyroid cancer is rare variant with very few reported cases. American Thyroid Association (ATA) Guidelines for Management of Patients with ATC do not include specific recommendations for this form of ATC. There is no consensus to define best treatment approach as to whether intrathyroidal incidentally detected ATC is best treated with surgery alone, surgery followed by radiotherapy, or surgery followed by chemotherapy plus radiation therapy. Conclusion: Based on review of our case as well as outcomes of similar reported cases, prognosis is favorable for incidental anaplastic thyroid cancer. Hopefully, with more data from similar cases to demonstrate difference in disease free survival we should be able to define the role of chemotherapy and adjuvant therapy for incidental ATC better. The question remains open, as to whether incidental anaplastic thyroid cancer should be considered as a separate entity from aggressive form of ATC.

scholarly journals Update on External Beam Radiation Therapy in Thyroid Cancer

2011 ◽  
Vol 96 (8) ◽  
pp. 2289-2295 ◽  
Author(s):  
James D. Brierley
Keyword(s):  
Radiation Therapy ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
External Beam Radiotherapy ◽  
Anaplastic Thyroid Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Primary Therapy ◽  
Beam Radiation ◽  
Effective Radiation

Abstract Surgery is the mainstay of treatment for thyroid cancer. The role for external beam radiotherapy (EBRT) as an adjuvant to surgery or as the primary therapy is established in anaplastic thyroid cancer but is controversial in differentiated thyroid cancer and uncertain in medullary thyroid cancer. This update reviews the recent reported success of combining EBRT with taxanes in anaplastic thyroid cancer. Also discussed are the recent reports from large single institutions that support the recommendations of the American and British Thyroid Associations on the use of EBRT in high-risk differentiated thyroid cancer. Further evidence on the role of EBRT in MTC is discussed. The important advances in the delivery of EBRT using intensity-modulated radiation and image-guided radiation that result in more accurate and potentially more effective radiation therapy with less toxicity are also discussed.

scholarly journals Whistle from Afar: A Case of Endotracheal Metastasis in Papillary Thyroid Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Bitoti Chattopadhyay ◽  
Biswamit Bhattacharya ◽  
Atri Chatterjee ◽  
Pijush Kanti Biswas ◽  
Nirod Baran Debnath
Keyword(s):  
Radiation Therapy ◽  
Thyroid Cancer ◽  
Gastrointestinal Tract ◽  
Papillary Carcinoma ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Papillary Thyroid ◽  
Beam Radiation ◽  
Rare Situation

Endotracheal metastasis is a rare situation, usually associated with malignancies of breast and gastrointestinal tract, specially colon. Papillary carcinoma of thyroid commonly disseminates through lymphatic channels and tracheal involvement through vascular route is rarely reported. Here, we report a case of tracheal metastasis from papillary carcinoma of thyroid. The patient responded to external beam radiation therapy with cobalt 60 beams in a dose of 44 Gy followed by a 16 Gy boost. The patient is under followup and is presently asymptomatic. This paper adds to the repertoire of evidence in treatment of endotracheal metastasis.

Contemporary Evaluation and Management of Parathyroid Carcinoma

2020 ◽  
pp. JOP.19.00540
Author(s):  
Abbey L. Fingeret
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Recurrent Disease ◽  
Tumor Burden ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Female Predominance ◽  
Males And Females ◽  
Rare Malignancy ◽  
Disease Free

Parathyroid carcinoma is a rare malignancy, representing 0.005% of all cancers and 0.5%-1% of all parathyroid disorders. Parathyroid carcinoma occurs equally in males and females, as opposed to primary hyperparathyroidism, which has a female predominance. Patients with parathyroid carcinoma present with symptoms of hypercalcemia, similar to those with benign primary hyperparathyroidism. Parathyroid carcinoma should be suspected when calcium or parathyroid hormone levels are high. Because of the difficulty of discerning parathyroid carcinoma from adenoma preoperatively, the diagnosis of carcinoma is often made only after parathyroidectomy. The goals of surgery are resection with negative margins because surgery represents the only opportunity for cure. Adjuvant therapy with chemotherapy or external beam radiation has not been proven to affect disease-free or overall survival for these patients. Recurrence is common, with reoperation recommended for resectable recurrent disease. Palliation with calcimimetic pharmacotherapy can aid with management of symptomatic hypercalcemia in recurrent or persistent disease after parathyroidectomy. Ultimately, patients succumb to sequelae of hypercalcemia rather than tumor burden.

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