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. 2017 May 1;123(9):1653-1661.
doi: 10.1002/cncr.30493. Epub 2016 Dec 27.

Radiation therapy dose is associated with improved survival for unresected anaplastic thyroid carcinoma: Outcomes from the National Cancer Data Base

Todd A Pezzi  1 , Abdallah S R Mohamed  2   3 , Tommy Sheu  2 , Pierre Blanchard  2 , Vlad C Sandulache  4 , Stephen Y Lai  5 , Maria E Cabanillas  6 , Michelle D Williams  7 , Christopher M Pezzi  8 , Charles Lu  9 , Adam S Garden  2 , William H Morrison  2 , David I Rosenthal  2 , Clifton D Fuller  2 , G Brandon Gunn  2
Affiliations

Radiation therapy dose is associated with improved survival for unresected anaplastic thyroid carcinoma: Outcomes from the National Cancer Data Base

Todd A Pezzi et al. Cancer. .

Abstract

Background: The outcomes of patients with unresected anaplastic thyroid carcinoma (ATC) from the National Cancer Data Base (NCDB) were assessed, and potential correlations were explored between radiation therapy (RT) dose and overall survival (OS).

Methods: The study cohort was comprised of patients who underwent either no surgery or grossly incomplete resection. Correlates of OS were explored using univariate analysis and multivariable analysis (MVA).

Results: In total, 1288 patients were analyzed. The mean patient age was 70.2 years, 59.7% of patients were women, and 47.6% received neck RT. The median OS was 2.27 months, and 11% of patients remained alive at 1 year. A positive RT dose-survival correlation was observed for the entire study cohort, for those who received systemic therapy, and for those with stage IVA/IVB and IVC disease. On MVA, older age (hazard ratio [HR], 1.317; 95% confidence interval [CI], 1.137-1.526), ≥ 1 comorbidity (HR, 1.587; 95% CI, 1.379-1.827), distant metastasis (HR, 1.385; 95% CI, 1.216-1.578), receipt of systemic therapy (HR, 0.637; 95% CI, 0.547-0.742), and receipt of RT compared with no RT (<45 grays [Gy]:HR, 0.843; 95% CI, 0.718-0.988; 45-59.9 Gy: HR, 0.596; 95% CI, 0.479-0.743; 60-75 Gy: HR, 0.419; 95% CI, 0.339-0.517) correlated with OS. The RT dose-survival correlation for patients who received higher (60-75 Gy) versus lower (45-59.9 Gy) therapeutic doses was confirmed by propensity-score matching.

Conclusions: Survival was poor in this cohort of patients with unresected ATC, and more effective therapies are needed. However, the association of RT dose with OS highlights the importance of identifying patients with unresected ATC who may still yet benefit from multimodal locoregional treatment that incorporates higher dose RT. Cancer 2017;123:1653-1661. © 2017 American Cancer Society.

Keywords: National Cancer Data Base; anaplastic thyroid carcinoma; head and neck; propensity-score matching; radiation therapy.

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Conflict of interest statement

Funding & Conflicts: The authors have no conflicts of interest or funding to disclose

Figures

Figure 1
Figure 1
Study cohort selection from the National Cancer Data Base (1998-2012). Those in the dashed red box were excluded from this study. (ATC: Anaplastic thyroid carcinoma; RT: Radiation therapy; Unk: Unknown; Gy: Gray)
Figure 2
Figure 2
Actuarial survival in unresected anaplastic thyroid carcinoma by neck radiation therapy group for the overall study cohort (A), those with stage IVA/IVB disease (B), those who received systemic therapy (C), and those with stage IVC disease (D). (RT: Radiation therapy; Gy: Gray)
Figure 3
Figure 3
Actuarial survival curves for the propensity score matched cohorts with anaplastic thyroid carcinoma (n=250). Shaded areas represent 95% confidence intervals and short vertical lines censored data.
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