Patterns of Loco-Regional Progression and Patient Outcomes After Definitive-Dose Radiation Therapy for Anaplastic Thyroid Cancer

Authors

Julianna K Bronk
Alexander Augustyn
Abdallah S R Mohamed
C David Fuller
Adam S Garden
Amy C Moreno
Anna Lee
William H Morrison
Jack Phan
Jay P Reddy
David I Rosenthal
Michael T Spiotto
Steven J Frank
Ramona Dadu
Naifa Busaidy
Mark Zafereo
Jennifer R Wang
Anastasios Maniakas
Renata Ferrarotto
Priyanka C Iyer
Maria E Cabanillas
G Brandon Gunn

Publication Date

1-1-2025

Journal

Radiotherapy Oncology

Abstract

Background: The aim of this study is to characterize the patterns of loco-regional progression (LRP) and outcomes after definitive-dose intensity modulated radiation therapy (IMRT) for anaplastic thyroid cancer (ATC) with macroscopic neck disease at the time of IMRT.

Methods: Disease/treatment characteristics and outcomes for patients with unresected or incompletely resected ATC who received IMRT (≥45 Gy) were retrospectively reviewed. For those with LRP after IMRT, progressive/recurrent gross tumor volumes (rGTV) were contoured on diagnostic CTs and co-registered with initial planning CTs using deformable image registration. rGTVs were classified based on established spatial/dosimetric criteria.

Results: Forty patients treated between 2010-2020 formed the cohort. Median IMRT dose was 66 Gy (45-70 Gy); altered fractionation (AF) was used in 24 (60 %). All received concurrent chemotherapy. In addition to areas of gross disease, target volumes (TVs) commonly included: central compartment/upper mediastinum (levels VI/VII), neck levels II-V in an involved, and levels III-IV in an uninvolved lateral neck. Median overall survival was 7.1 m. Median progression free survival was 7.4 m for patients with locoregional disease and 1.8 m for patients with distant metastasis at the time of IMRT. Twenty-one patients (53 %) developed LRP at median of 10.9 m; freedom from LRP at 3 m and 12 m was 71 % (95 %CI 58-87 %) and 47 % (95 %CI 32-68 %). Forty-one individual rGTVs were identified and most occurred within the high dose (HD) TVs: Type A/central HD (n = 29, 71 %) and B/peripheral HD (n = 3, 7 %).

Conclusions: Despite an intensive treatment schedule, including AF and concurrent chemotherapy, classic radio-resistant and rapid Type A failures predominated; isolated extraneous dose failures were rare. While these findings support the IMRT and TV delineation strategies described herein, they highlight the importance of identifying novel strategies to further improve LRC for patients with unresectable disease without targetable mutations for contemporary neo-adjuvant strategies.

Keywords

Humans, Male, Female, Radiotherapy, Intensity-Modulated, Aged, Thyroid Carcinoma, Anaplastic, Middle Aged, Retrospective Studies, Disease Progression, Thyroid Neoplasms, Aged, 80 and over, Radiotherapy Dosage, Neoplasm Recurrence, Local, Treatment Outcome, Adult, Anaplastic thyroid cancer, Definitive intensity modulated radiation therapy, Patterns of failure.

DOI

10.1016/j.radonc.2024.110602

PMID

39489425

PMCID

PMC11720968

PubMedCentral® Posted Date

1-10-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes