Successful Treatment of Anaplastic Thyroid Carcinoma with a Combination of Oral Valproic Acid, Chemotherapy, Radiation and Surgery
Successful Treatment of Anaplastic Thyroid Carcinoma with a Combination of Oral Valproic Acid, Chemotherapy, Radiation and Surgery
复制标题
DOI：
10.1507/endocrj.k08e-016
复制
发表时间：
2009-04-01
影响因子：
2
通讯作者：
Noguchi, Shiro
中科院分区：
文献类型：
--
作者：
Noguchi, Hitoshi;Yamashita, Hiroto;Noguchi, Shiro
甲状腺间变性癌(ATC)是甲状腺癌中侵袭性最强的一种，其治疗方法尚未确立，死亡率极高。最近的体外研究表明，丙戊酸(VA)是一种新发现的组蛋白去乙酰化酶(HDAC)抑制剂，它可以诱导细胞凋亡，调节甲状腺肿瘤分化基因的表达，并增强间变性癌细胞对阿霉素的敏感性。我们报告一例以丙戊酸、顺铂和阿霉素为主的化疗、术中放疗和手术相结合的方法成功治疗甲状腺未分化癌的病例。在治疗过程中，CT测量的肿瘤体积缩小了50.7%，超声测量的肿瘤体积缩小了44.6%。在每个化疗周期之间，没有观察到肿瘤大小的明显反弹。通过细针抽吸(FNA)进行的连续细胞学检查显示了细胞类型的快速变化，从间变性开始，直到呈现出越来越好的分化。在切除的甲状腺组织学检查中仅发现微小的ATC细胞残留物。手术后6个月的GA核素扫描和全身PET扫描显示没有复发或转移的证据。截至2008年11月22日，患者在确诊后两年内仍活着，没有疾病。
Anaplastic thyroid carcinoma (ATC) is the most aggressive of thyroid cancers whose treatment is not yet established and mortality is extremely high. Recent in vitro studies have shown that valproic acid (VA), a newly identified histone deacetilase (HDAC) inhibitor, induces apoptosis, modulates differentiation gene expression of thyroid tumors and enhances the sensitivity of anaplastic cancer cell lines to doxorubicin. We report a case of successful treatment of anaplastic thyroid carcinoma with a combination of oral valproic acid, chemotherapy consisting of cisplatin and doxorubicin, external and intra-operative radiation and surgery. Tumor volume decreased by 50.7% under CT measurement and 44.6% under sonogram measurement over the course of the treatment. No significant rebound of tumor size was observed between each cycle of chemotherapy. Serial cytology performed via fine needle aspiration (FNA) presented a rapidly changing profile of cell types, starting with anaplastic and proceeding through increasingly well differentiated presentations. Only microscopic remnants of ATC cells were found in the histological examination of the resected thyroid. Ga scintigraphy and whole body PET scan six months after surgery revealed no evidence of recurrence or metastasis. As of Nov. 22, 2008, the patient is alive and disease free two years after diagnosis.