Anaplastic thyroid carcinoma: A 50-year experience at a single institution

Background. Anaplastic thyroid carcinoma (ATC) is among the most aggressive of human malignancies. However there have been few large studies of histologically well-defined ATC. We report the results of a 50-year experience of this lethal malignancy. Methods. We reviewed all cases of ATC managed in this institution between 1949 and 1999. One pathologist (J.R.G.) reviewed all pathologic material. Clinical details were obtained from medical records, and current status of all patients was determined. Results. There were 134 cases, with a female-to-male ratio of 1.5:1 and a mean age of 67 years. Benign thyroid disease was present in 27 cases (20%) and well-differentiated thyroid carcinoma in 31 (23%). Sixty-two patients (46%) had distant metastases at diagnosis, and 98% of the tumors were locally invasive. Primary treatment was surgical for 96 patients (72%). Complete resection was achieved in 29 cases (30%), with "minimal residual disease" in 25. Neither extent of operation nor completeness of resection affected survival (P > .4). Postoperative radiotherapy gave slightly longer median survival (5 vs 3 months), which was not significant (P < .08). Multimodal therapy, including operation, chemotherapy, and radiotherapy, did not improve survival. Conclusions. The outlook for patients with ATC remains grim. Novel treatments for ATC are desperately needed.