Role of surgery in anaplastic carcinoma of the thyroid
Anaplastic carcinoma of the thyroid accounts for < 1% of thyroid cancers but is one of the most aggressive solid tumors known and is rarely curable. Median survival is about 6 months. At the time of diagnosis, 50% of patients harbor distant metastases, and 95% have local invasion precluding curative resection. Thus, surgery is usually restricted to a diagnostic or palliative role. Incisional biopsy of the thyroid is sometimes necessary to differentiate anaplastic cancer from thyroid lymphoma, poorly differentiated thyroid cancer, or metastasis to the thyroid gland because the treatments and outcomes are very different. Palliative surgical debulking and tracheostomy should be reserved for patients with airway compromise because they do not prolong survival. An attempt at a curative resection should be reserved for younger patients who do not have distant disease and only when all gross cervical and mediastinal disease can be resected without excessive morbidity. In this select subgroup of patients, curative-intent surgery combined with adjuvant external beam radiation and/or chemotherapy has been shown to prolong survival compared with patients treated with adjuvant therapy alone. Recent studies have shown promising results with the use of combined tyrosine kinase inhibitors, dabrafenib, and trametinib.