EARLY SURGERY AND SURVIVAL OF PATIENTS WITH ANAPLASTIC THYROID CARCINOMA: ANALYSIS OF A CASE SERIES REFERRED TO A SINGLE INSTITUTION BETWEEN 1999 - 2012.

Background: Extensive resection of the tumor has been associated with better survival of anaplastic thyroid carcinoma (ATC) patients. However, surgery is not the rule for ATC patients with distant metastases at the time of diagnosis (stage IV-C), regardless of tumor resectability. The aim of this work was to explore the potential role of surgery in ATC patients, including those in stage IV-C. Methods: We considered all the consecutive ATC patients referred to our Institution from June 1999 to July 2012. Patients with stage IV-A incidentally discovered ATC were excluded because of their better prognosis. All patients eligible for surgery at the time of diagnosis were firstly operated with the intent to obtain a macroscopically complete resection (R0, R1), or a R2 resection with minimal macroscopical residual tumor. These operations were defined "maximal debulking", whereas operations that did not achieve this goal were defined as "partial debulking". After surgery, almost all patients received adjuvant chemotherapy, associated to radiotherapy in more than one half . Results: There were 55 eligible patients (34 women; median age 73.15 years). Thirty-one patients had distant metastases (stage IV-C). The median overall survival was 5.55 months (95% CI: 4.94 - 6.60), with no difference according to stage. "Maximal debulking" was obtained in 70.73% of firstly operated patients and resulted associated with better survival than "partial debulking" (6.57 months, 95% CI: 5.52 - 12.09 vs 3.25 months, 95% CI: 0.66 - 4.80), without any difference between stage IV-B and IV-C patients. Furthermore, 21% of patients submitted to "maximal debulking" died for local progression of the tumor, whereas it was the case for 69% of patients treated with "partial debulking" or not operated at all. Conclusions: Early "maximal debulking", followed by adjuvant therapy, can improve the survival and ameliorate the quality of residual life preventing the risk of suffocation. This effect is observed also in patients with distant metastasis at diagnosis, that treated in this way have an outcome similar to that observed in stage IV-B patients. We thus suggest that surgery may be considered in the management of all ATC patients, and not restricted a priori to stages IV-A and IV-B.