Serkan ERKAN, Hakan YABANOĞLU, Ramazan GÜNDOĞDU, Murat KUŞ

Anaplastik Tiroid Karsinomlu Hastalarda Cerrahi Tedavi Yönetimimiz

Amaç: Anaplastik tiroid karsinomu, nadir görülmekle birlikte en agresif seyirli olan tiroid kanseridir. Kısıtlı sayıdaki hastaya cerrahi tedavi uygulanabilmekte ve sonuçları halen yüz güldürücü olmamaktadır. Bu çalışmada kliniğimizde anaplastik tiroid karsinomu nedeniyle tedavi uygulanan hastaların sonuçlarının literatüre sunulması amaçlanmıştır. Gereç ve Yöntem: 2015-2020 tarihleri arasında kliniğimizde anaplastik tiroid karsinomu tanısı ile tedavi edilen hastaların dosyaları geriye dönük olarak incelendi. Cerrahi tedavileri kliniğimizde yapılan 18 yaşından büyük 10 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, yakınma, ultrasonografi, bilgisayarlı tomografi, iğne biyopsisi sonuçları, preoperatif vokal kord muayeneleri, cerrahi ve onkolojik tedavileri ile survey bilgileri kaydedilerek analiz edildi. Bulgular: Hastaların 6’sı erkek, 4’ü kadındı. Yaş ortalaması 68,5 (53-86) idi. Hastaların tamamında basıya bağlı nefes darlığı yakınması mevcuttu. Bilgisayarlı tomografi taramalarında 5 hastada akciğer metastazı, 4 hastada rejyonel lenf nodu metastazı bulunmaktaydı. Sekiz hastaya ince iğne aspirasyon biyopsisi yapıldı ve sonucu malignite ile uyumluydu. Preoperatif vokal kord muayenelerinde 7 hastada unilateral paralizi mevcuttu. Hastaların tamamına cerrahi tedavi, ek olarak 8 hastaya kemoradyoterapi, 2 hastaya da radyoterapi yapıldı. Hastaların tümünün postoperatif progresif hastalık bulgusu gösterdiği ve eksitus olduğu görüldü. Ortalama survey 150 (4-420) gündü. Sonuç: Anaplastik tiroid karsinomu tanı ve tedavi yönetimi güç bir hastalıktır. Multidisipliner yaklaşımla yönetilmesine rağmen halen yüksek mortalite oranlarına sahiptir. Tiroid patolojisi öyküsü olan hastalarda anaplastik karsinom gelişimi olabileceği akılda tutulmalı ve titizlikle değerlendirilmelidir.

Anahtar Kelimeler:

bilateral total tiroidektomi, boyun diseksiyonu, metastaz, Anaplastik Tiroid Kanseri

Our Surgical Treatment Management in Patients with Anaplastic Thyroid Carcinoma

Objective: Anaplastic thyroid carcinoma is a rare, but most aggressive, thyroid cancer. Surgical treatment can be applied to a limited number of patients and the results are still not satisfactory. In this study, it is aimed to present the results of patients treated for anaplastic thyroid carcinoma in our clinic to the literature. Materials and Methods: The files of patients who were treated with the diagnosis of anaplastic thyroid carcinoma in our clinic between 2015-2020 were retrospectively analyzed. Ten patients over 18 years of age, who underwent surgical treatments in our clinic, were included in the study. Patients' age, gender, complaints, ultrasonography, computed tomography, needle biopsy results, preoperative vocal cord examinations, surgical and oncological treatments, and survey information were recorded and analyzed. Results: 6 of the patients were male and 4 were female. The average age was 68.5 (53-86). All patients had shortness of breath due to compression. Computed tomography scans revealed lung metastasis in 5 patients and regional lymph node metastasis in 4 patients. Fine needle aspiration biopsy was performed in eight patients and the result was consistent with malignancy. In preoperative vocal cord examinations, 7 patients had unilateral paralysis. Surgical treatment was applied to all patients, chemoradiotherapy to 8 patients and radiotherapy to 2 patients. It was observed that all of the patients showed signs of postoperative progressive disease and died. Average surveillance was 150 (4-420) days. Conclusion: Anaplastic thyroid carcinoma is a disease that is difficult to diagnose and treat. Despite being managed with a multidisciplinary approach, it still has high mortality rates. It should be kept in mind that patients with a history of thyroid pathology may develop anaplastic carcinoma and should be evaluated carefully.

Keywords:

Anaplastic thyroid cancer, bilateral total thyroidectomy, neck dissection, metastasis,

PDF

___

Siegel RL, Miller KD, Jemal A. Cancer Statistics, CA Cancer J Clin. 2017;67(1):7-30.
Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer. 1998;83(12):2638-2648.
Ain KB. Anaplastic thyroid carcinoma: a therapeutic challenge. Semin Surg Oncol. 1999;16(1):64-69.
Nel CJ, van Heerden JA, Goellner JR, et al. CS. Anaplastic carcinoma of the thyroid: a clinicopathologic study of 82 cases. Mayo Clin Proc. 1985 Jan;60(1):51-8.
Simões-Pereira J, Capitão R, Limbert E, et al. Anaplastic Thyroid Cancer: Clinical Picture of the Last Two Decades at a Single Oncology Referral Centre and Novel Therapeutic Options. Cancers (Basel). 2019 Aug 15;11(8).
Oktay MH, Smolkin MB, Williams M, et al. Metastatic anaplastic carcinoma of the thyroid mimicking squamous cell carcinoma: report of a case of a challengin gcytologic diagnosis. ActaCytol 2006;50:201-04.
Are C, Shaha AR. Anaplastic thyroid carcinoma: biology, pathogenesis, prognostic factors, and treatment approaches. Ann Surg Oncol 2006;13:453-64.
Pierie JP, Muzikansky A, Gaz RD, et al. The effect of surgery andradio therapy on outcome of anaplastic thyroid carcinoma. Ann Surg Oncol 2002;9:57-64.
Limaiem F, Kashyap S, Naing PT, Giwa AO. Anaplastic Thyroid Cancer. Treasure Island (FL): StatPearls Publishing; July 20, 2021.
Kloos RT, Eng C, Evans DB, et al. American Thyroid Association Guidelines Task Force. Medullary Thyroid Cancer: Management Guidelines of the AmericanThyroid Association. Thyroid. 2009;19:565–612.
Smallridge RC, Ain KB, Asa SL, et al. American Thyroid Association Anaplastic Thyroid Cancer Guidelines Taskforce. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012 Nov;22(11):1104-39.
Chintakuntlawar AV, Foote RL, Kasperbauer JL,et al. Diagnosis and Management of Anaplastic Thyroid Cancer. Endocrinol Metab Clin North Am. 2019 Mar;48(1):269-284.
McIver B, Hay ID, Giuffrida DF, et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery. 2001 Dec;130(6):1028-34.
Burinicardi F Charles et al. Schwartz’s principels of surgery. In: Lal G, Clark HO. Thyroid, parathyroid, adrenal. McGraw Hill Company, Ninth Edition, Newyork 2010:1343-1408.
Neff LR, Farrar BW, Kloos TR. Anaplastic thyroid cancer. Endocrinol Metab Clin N Am 2008;37:525-38.
Akaishi J, Sugino K, Kitagawa W, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid. 2011 Nov;21(11):1183-9.
Sun C, Li Q, Hu Z, et al. Treatment and prognosis of anaplastic thyroid carcinoma: experience from a single institution in China. PLoSOne. 2013;8(11):e80011.
Haddad RI, Lydiatt WM, Ball DW, et al. Anaplastic thyroid carcinoma, version22015. J Natl Compr Cancer Netw. 2015;13(9):1140–50.
Krasovec M, Golouh R, Auersperg M. Anaplastic carcinoma in fine needle aspirates. ActaCytol 1996;40:953-8.
Hahn SY, Shin JH. Description and comparison of the sonographic characteristics of poorly differentiatedthyroid carcinoma and anaplastic thyroid carcinoma. J Ultrasound Med 2016;35:1873–79 .
Carcangiu ML, Steeper T, Zampi G et al. Anaplastic thyroid carcinoma. A study of 70 cases A ClinPathol 1985; 83: 135-58.
Ito K, Hanamura T, Murayama K, et al. Multimodality therapeutic outcomes in anaplastic thyroid carcinoma: improved survival in subgroups of patients with localized primary tumors. Head Neck. 2012;34:230–7.
Fagin JA, Wells SAJ. Biologic and clinical perspectives on thyroid Cancer. N Engl J Med. 2016;375(11):1054–67.
Sherman SI. Thyroid carcinoma. Lancet. 2003;361(9356):501–11.
Nel CJC, vanHeerden JA, Goellner JR, et al. Anaplastic carcinoma of the thyroid: a Clinicopathologic study of 82 cases. Mayo ClinProc. 1985;60(1):51–8.
McIver B, Hay ID, Giuffrida DF,et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery. 2001;130(6):1028–34.
Tallroth E, Wallin G, Lundell G, et al. Multimodality treatment in anaplastic giantcell thyroid carcinoma. Cancer 1987;60:1428–31.
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901-11.