RESUMO
The authors report a case of anaplastic thyroid carcinoma which was treated with chemotherapy and radiotherapy and proved to achieve pathological CR (complete response) after a radical operation. A 53-year-old female presented with a mass of about 4 cm in diameter arising from the left lobe of her thyroid and surrounding her cervical esophagus. Pre-operative aspiration cytology and open biopsy revealed the tumor was a giant cell anaplastic carcinoma. There was no sign of distant metastasis. Two cycles of chemotherapy were very effective in treating the tumor but regrowth appeared to occur during hyperfractionated radiotherapy. A radical operation, including a resection of the larynx, cervical trachea and esophagus, was successfully performed and no living cancer cells, only granulation and necrosis, were observed in the operation specimen. The patient has been alive for over 2 years since without any evidence of recurrence.
Assuntos
Carcinoma de Células Gigantes/tratamento farmacológico , Carcinoma de Células Gigantes/radioterapia , Fracionamento da Dose de Radiação , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/radioterapia , Tireoidectomia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Carcinoma de Células Gigantes/patologia , Carcinoma de Células Gigantes/cirurgia , Quimioterapia Adjuvante , Terapia Combinada , Diagnóstico por Imagem , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Esvaziamento Cervical , Necrose , Radioterapia Adjuvante , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
PURPOSE: The aim of this paper is to evaluate efficacy of radiotherapy for giant cell tumor of bone given either postoperatively or as sole treatment, and to assess prognostic factors for treatment outcome. METHODS AND MATERIALS: The study includes 37 patients. In 9 cases, soft tissue involvement was noted. Nonradical operation followed by radiotherapy was given to 23 patients, and 14 patients received irradiation only. Total dose of 39--64 Gy was delivered. The average follow-up was 5 years. Probability of local tumor control (LTC) depending on the treatment strategy was calculated, and prognostic factors were assessed. RESULTS: LTC was noted in 31 cases. Ten-year LTC for surgery with irradiation was 83% and 69% for radiotherapy alone; however, this difference was not statistically significant. For tumors smaller than 4 cm LTC probability was above 90%, and it decreased to less than 60% for tumors larger than 8.5 cm. No dose-response relationship has been found. In 7 cases, late normal tissue effect occurred. CONCLUSIONS: Giant cell tumors of bone can be considered as radiosensitive and radiotherapy with total dose of 40--45 Gy seems to be an effective sole treatment especially for tumors smaller than 4 cm in diameter. For larger tumors, surgery combined with postoperative radiotherapy should be considered.
