Neoadjuvant Chemotherapy in 13 Patients with Locally Advanced Poorly Differentiated Thyroid Carcinoma based on Turin proposal – A Phase 1/2 Study

Abstract

Background. There is a paradigm that chemotherapy is ineffective in thyroid carcinoma. The aim of our study was to find out whether neoadjuvant chemotherapy before thyroid surgery had an effecton the size of primary tumor in patients with poorly differentiated thyroid carcinoma (PDTC) based on Turin proposal. Patients/Methods. Altogether, 13 patients (8 women, 5 men; median age 61 years) with PDTC were treated with neoadjuvant chemotherapy between 1986 and 2005. Tumor diameter was from 4.5 to 18 cm (median 9 cm). Regional and distant metastases were detected in 6 and 9 patients, respectively. Eight patients had pT4 tumor. Results. Altogether, 29 (range 1-5) cycles of chemotherapy were given. Tumor diameter decreased in all the patients and by more than 30% in 5 patients (= 38%). Three of these five patients had also preoperative external beam irradiation (EBRT). Total thyroidectomy, lobectomy and neck dissection were performed in 10, 3 and 5 cases, respectively. R0 and R1 resection was done in 5 and 8 cases,respectively. Eight patients had postoperative EBRT of the neck and upper mediastinum. The 5-year and 10-year cause-specific survival rates of patients were 66% and 20%, respectively. Conclusions.  After neoadjuvant chemotherapy a partial tumor regression was observed in 38% of patients with PDTC.