Thyroid cancer: different outcomes to chemotherapy according to tumour histology.

IN THE MANAGEMENT of thyroid carcinoma, doxorubicin alone, or in combination with cisplatin , is considered the most active regimen, although it gives unsatisfactory response rates with significant side-effects [1-3]. Epirubicin is endowed with a spectrum of activity similar to doxorubicin and an equivalent response rate with less cardiotoxicity and acute myelosuppres­ sion [4, 5]. Carboplatin produces less nephrolOxicity, neurotox­ icity and vomiting than cisplatin [6 , 7]. In an attempt lO identify a well tolerated regimen which does not affect patients' quality of life, the association of epirubicin 75 mg/m2 given by i.v. (intravenous) bolus on day l, and carboplatin 100 mg/m2 by 30 min infusion on days 1-3, repeated every 28 days, was proposed as fust-line chemotherapy to pati­ ents aged ,,; 70 years, ECOG perfonnance status ,,; 2, affected by histologically proven thyroid carcinoma (except medullary) not suitable for surgery or radioactive iodine . Eight cycles were planned except for the cases showing progressive disease. Response and toxicity were evaluated according to WHO-UICC criteria [8] . 20 patients entered the study: all were suitable for the evalu­ ation of response and toxicity. lO patients were male and lO female, the median age was 64 years (range 35-70), ECOG perfonnance status was O in 8 patients and l in 12. Sites of disease were thyroid (8 patients), local relapse (7), regional nodes (12), distant nodes (3), lung (12) and bone (1 ). 12 patients were pretreated with locoregional surgery, 5 with radioactive iodine and 2 with radiotherapy. A total of 83 cycles of chemotherapy have been delivered, with a median of four cycles per patient (range 1-8). Treatment was well lOlerated. No cases of grade 4 toxicity occurred; grade 3 anaemia occurred in 15% of patients, leucopenia was observed 'in 5% and nausea/vomiting in 5%. Alopecia was complete in 7 patients . 2 male patients achieved complete responses both lasting 12+ months: they were 70 years old with disease limited to the regional nodes, and in one case, local relapse . In these cases, the time to the best response was 5 and 3 months, respectively. One patient achieved a partial response lasting 4 months; 7 patients had stable disease for a median duration of 9 months (range