Anaplastik Tiroid Kanserleri
Özet
Anaplastik tiroid kanseri (ATK), tiroid foliküler epitelinin farklılaşmamış tümörleri olup, yüzde 100’e yaklaşan mortalite oranıyla son derece agresif bir seyir gösterir. Genellikle 65 yaş civarında ve çoğunlukla kadınlarda saptanan bu hastalık, tüm tiroid kanserlerinin yüzde 0,9 ila 9,8’ini oluşturur. Hastalar çoğunlukla hızla büyüyen sert bir boyun kitlesi, ağrı, dispne ve disfaji şikayetleriyle başvururlar. Tanı anında vakaların yüzde 90’ında bölgesel invazyon veya başta akciğer olmak üzere uzak metastazlar mevcuttur. Tanı ince iğne aspirasyon sitolojisiyle konur ve tüm ATK’ler evre IV olarak kabul edilir. Tedavi yaklaşımı multidisipliner olup hastalığın evresine ve moleküler mutasyon durumuna göre belirlenir. BRAF V600E mutasyonu pozitif olan rezektabl hastalarda total tiroidektomi sonrası kemoradyoterapi uygulanırken, inoperabl vakalarda dabrafenib ve trametinib gibi hedefe yönelik neoadjuvan tedaviler tercih edilir. Mutasyon negatif veya metastatik hastalarda ise cerrahi rezeksiyon, sisplatin ve paklitaksel bazlı sitotoksik kemoterapiler, lenvatinib ve pembrolizumab gibi immünoterapi kombinasyonları veya palyatif bakım seçenekleri devreye girer. Ortalama sağkalım süresi 3-7 ay arasında değişmekte olup, hava yolu güvenliğinin sağlanması ve semptomların hafifletilmesi palyatif süreçlerin temelini oluşturmaktadır.
Anaplastic thyroid cancer (ATC) represents undifferentiated tumors of the thyroid follicular epithelium, exhibiting an extremely aggressive clinical course with a disease-specific mortality rate approaching 100%. Typically diagnosed at a median age of 65 and predominantly affecting women, ATC accounts for 0.9% to 9.8% of all thyroid malignancies globally. Patients primarily present with a rapidly growing, firm neck mass, often accompanied by neck pain, dyspnea, and dysphagia. At initial diagnosis, regional extension or distant metastases—most commonly localized in the lungs—are present in 90% of cases. Diagnosis is established via fine-needle aspiration biopsy, and all cases are classified as stage IV. Management relies on a multimodal approach guided by disease stage and molecular testing. For resectable stage IVA tumors with a BRAF V600E mutation, total thyroidectomy followed by adjuvant chemoradiotherapy is recommended, whereas unresectable cases benefit from neoadjuvant dabrafenib and trametinib. In BRAF wild-type or metastatic disease, treatment options encompass surgical debulking, cytotoxic chemotherapies such as cisplatin and paclitaxel, immunotherapy combinations like lenvatinib and pembrolizumab, or palliative care. The median survival ranges between 3 to 7 months, underscoring the vital importance of airway management and symptom alleviation.
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