High efficacy of concomitant treatment of undifferentiated (anaplastic) thyroid cancer with radiation and docetaxel

J Clin Endocrinol Metab. 2010 Sep;95(9):E54-7. Epub 2010 Jun 30.

Troch M , Koperek O , Scheuba C , Dieckmann K , Hoffmann M , Niederle B , Raderer M

Anaplastic thyroid carcinoma (ATC) is a rare but aggressive solid tumor with a very short survival time even with multimodality treatment. In view of in vitro data and the high rate of p53 mutations in ATC, we have used combined treatment with external beam radiation and docetaxel. The design was a retrospective analysis. A total of six patients with ATC were treated at our institution. Treatment consisted of standard external beam radiation of 60.0 Gy in 30 fractions along with docetaxel at a dose of 100 mg absolute every 3 wk for a total of six cycles starting within the first week of radiation.

Five patients completed radiochemotherapy. One patient has completed radiation but is still on treatment with docetaxel. Four patients achieved complete remission and two partial response. During radiation therapy, four patients developed severe mucositis/stomatitis and two dermatitis, necessitating hospitalization. Two patients developed pneumonia and one urinary tract infection. All patients were hospitalized for a median of 17 d (range, 4-40 d) because of toxicites. After a median follow up of 21.5 months (range, 2-40 months), five patients are alive.The preliminary data suggest that the combination of radiation and concomitant docetaxel is highly effective in patients with ATC. However, a formal phase II study is needed to assess the therapeutic potential of this combination.

Comment

Most studies of chemotherapy of anaplastic thyroid carcinoma have been very disappointing, including a report several years ago on the same topic by Robert Leper, who also used radiation plus chemo. This report in contrast finds a very strong positive effect, and needs confirmation in further studies.