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PATIENT HISTORY AND TREATMENT
The patient was a female, 65 years old. Early in 1996, she began to feel intermittent discomfort in her neck, accompanied with hoarseness. In June, 2000, when she entered our hospital and accepted a physical examination, we found a 3 cm×2 cm tumor at the lower pole of the thyroid gland. Neck CT showed that the mass was located at the inferiorposterior right part of the thyroid gland with a diffuse boundary. MRI showed that the right thyroid cartilage wall was incomplete. Fine-needle aspiration cytology indicated a suspected papillary tumor.
On September 5, 2000, she underwent an operation involving a radical correction, segment excision of the neck section of the esophagus and trachea end-to-end anastomosis. Post-surgery pathology showed the thyroid to be a moderately to poorly differentiated squamous carcinoma, with infringement into the esophagus. Later from October to November, 2000, she received radiotherapy of the entire neck and mediastinum: 4,000 cGy/20F, thyroid gland area with an electron beam: 1,400 cGy/7F. In April, 2005,when she was reexamined, CT showed lesions in the left front thoracic wall, the left heart margin and in the lung. ECT showed multiple bone metastases. On April 21, 2006, afer a thoracoscopic biopsy, the post-surgery pathology diagnosis was pleural membrane metastases. From May to July, 2006, she underwent chemotherapy in our branch using a TP regimen. The tumor size failed to change significantly after 2 cycles, but after 4 cycles, we found that the size of the lesion in the lung and pleural membrane had reduced, and the evaluation was SD(stable disease). The patient is alive at the present time.
DISCUSSION
Primary thyroid gland squamous carcinoma is very rare. It belongs to a type of undifferentiated carcinoma, making up about 1% in all thyroid cancers[1]. It is more common in patients above 40 years of age, with a high degree of malignancy and invasive capacity. The treatment of thyroid gland squamous carcinoma is mainly by surgery, but most receive only a palliative excision. Chemotherapy and radiotherapy can be used after operation, such as treatment employing Cisplatin(DDP), Methotrexate(MTX), Adriamycin(ADM), etc., but results are not satisfactory. For example, Jereb et al.[2] used MTX to treat patients, whose average lifetime was only from 2.5 months to 9.4 months. Gottlieb et al.[3] utilizing ADM chemotherapy obtained PR in 3 out of 5 patients.
The prognosis of this tumor is extremely poor, with the 5-year survival rate being lower than 5%. In our case, the patient accepted radical correction, and the surgery range was expanded. After the operation, radiotherapy was applied using a total dose of 5,400 cGy/27F. After multiple metastases appeared, we used a TP chemotherapy regimen based on targeting the head and neck tumors: Docetaxel 75 mg/m2, d1, Cisplatin, 75 mg/m2, d1, q3w. After 4 cycles, we found the size of the lesion was reduced. The patient has survived for more than six years from the operation. The treatment method and the experience in this report can be of value for other oncologists faced with this malignancy.
- Received February 12, 2007.
- Accepted March 9, 2007.
- Copyright © 2007 by Tianjin Medical University Cancer Institute & Hospital and Springer
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