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Radiation therapy dose is associated with improved survival for unresected anaplastic thyroid carcinoma: Outcomes from the National Cancer Data Base
Author(s) -
Pezzi Todd A.,
Mohamed Abdallah S. R.,
Sheu Tommy,
Blanchard Pierre,
Sandulache Vlad C.,
Lai Stephen Y.,
Cabanillas Maria E.,
Williams Michelle D.,
Pezzi Christopher M.,
Lu Charles,
Garden Adam S.,
Morrison William H.,
Rosenthal David I.,
Fuller Clifton D.,
Gunn G. Brandon
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30493
Subject(s) - medicine , hazard ratio , cohort , radiation therapy , confidence interval , cancer , proportional hazards model , cancer registry , surgery , univariate analysis , urology , multivariate analysis
BACKGROUND The outcomes of patients with unresected anaplastic thyroid carcinoma (ATC) from the National Cancer Data Base (NCDB) were assessed, and potential correlations were explored between radiation therapy (RT) dose and overall survival (OS). METHODS The study cohort was comprised of patients who underwent either no surgery or grossly incomplete resection. Correlates of OS were explored using univariate analysis and multivariable analysis (MVA). RESULTS In total, 1288 patients were analyzed. The mean patient age was 70.2 years, 59.7% of patients were women, and 47.6% received neck RT. The median OS was 2.27 months, and 11% of patients remained alive at 1 year. A positive RT dose‐survival correlation was observed for the entire study cohort, for those who received systemic therapy, and for those with stage IVA/IVB and IVC disease. On MVA, older age (hazard ratio [HR], 1.317; 95% confidence interval [CI], 1.137‐1.526), ≥ 1 comorbidity (HR, 1.587; 95% CI, 1.379‐1.827), distant metastasis (HR, 1.385; 95% CI, 1.216‐1.578), receipt of systemic therapy (HR, 0.637; 95% CI, 0.547‐0.742), and receipt of RT compared with no RT (<45 grays [Gy]:HR, 0.843; 95% CI, 0.718‐0.988; 45‐59.9 Gy: HR, 0.596; 95% CI, 0.479‐0.743; 60‐75 Gy: HR, 0.419; 95% CI, 0.339‐0.517) correlated with OS. The RT dose‐survival correlation for patients who received higher (60‐75 Gy) versus lower (45‐59.9 Gy) therapeutic doses was confirmed by propensity‐score matching. CONCLUSIONS Survival was poor in this cohort of patients with unresected ATC, and more effective therapies are needed. However, the association of RT dose with OS highlights the importance of identifying patients with unresected ATC who may still yet benefit from multimodal locoregional treatment that incorporates higher dose RT. Cancer 2017;123:1653–1661. © 2017 American Cancer Society .