Induction Chemotherapy Using Doxorubicin and Cisplatin Followed by Combretastatin A4 Phosphate and Radiation Therapy in Treating Patients With Newly Diagnosed Regionally Advanced Anaplastic Thyroid Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed anaplastic or poorly differentiated variant thyroid carcinoma of either of the following:

  • Regionally advanced disease

    • Confined to the neck and/or superior mediastinum (i.e., above the level of the carina)
    • Measurable or evaluable* disease
  • Completely resected disease without measurable or evaluable disease NOTE: *At a minimum, abnormalities on physical exam or radiographic studies that may not be precisely measured but readily followed

• Must have original/diagnostic tumor blocks available to confirm histopathology and for tumor microvessel density immunohistochemistry

  • Patients with no available original/diagnostic tumor blocks must have tumor accessible for pretreatment needle core biopsy
• Must undergo indirect and direct laryngoscopy to ensure patency of the trachea/airway if deemed inoperable, with bulky thyroid/neck masses and/or suspicion of airway obstruction

• No distant metastases, including but not limited to, brain metastases, disease below the level of the carina, pulmonary parenchyma, and hepatic or bony metastases

  • Superior mediastinal disease (i.e., above the level of the carina) in addition to regional neck disease is allowed provided the disease can be contained in a single radiotherapy port

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-2

Life expectancy

• At least 12 weeks

Hematopoietic

• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 75,000/mm^3
• Hemoglobin ≥ 8.5 g/dL

Hepatic

• Bilirubin ≤ 1.5 mg/dL
• ALT and AST ≤ 3.5 times upper limit of normal

Renal

• Creatinine ≤ 1.5 mg/dL

Cardiovascular

• LVEF ≥ 50% by echocardiogram
• EKG normal
• No prior angina
• No prior myocardial infarction (e.g., significant Q waves), QTc > 450 msec, or other clinically significant abnormalities on ECG
• No congestive heart failure

• No uncontrolled atrial arrhythmias or clinically significant arrhythmias, including any of the following:

  • Conduction abnormality
  • Nodal junctional arrhythmias and dysrhythmias
  • Sinus bradycardia or tachycardia
  • Supraventricular arrhythmias
  • Atrial fibrillation or flutter
  • Syncope or vasovagal episodes
• No significant heart wall abnormality or heart muscle damage by echocardiogram

• No uncontrolled hypertension (i.e., blood pressure consistently greater than 150/100 mm Hg irrespective of medication)

  • Hypertension is allowed provided there is clinical documentation of controlled blood pressure for 2 months before study entry
• No symptomatic peripheral vascular disease or cerebrovascular disease

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No uncontrolled hypokalemia or hypomagnesemia
• No concurrent serious infection
• No other nonmalignant uncontrolled medical illness or one whose control may be jeopardized by the complications of study therapy
• No grade 2 or greater pre-existing motor or sensory peripheral neuropathy
• No psychiatric disorder or other condition that would preclude study compliance
• No conditions associated with QTc prolongation

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No concurrent biologic therapy
• No concurrent immunotherapy

Chemotherapy

• No prior chemotherapy
• No other concurrent chemotherapy

Endocrine therapy

• No concurrent hormonal therapy, except for the following:

  • Gonadotropin-releasing hormone agonists for patients with hormone-refractory prostate cancer
  • Hormone replacement therapy
  • Oral contraceptives
  • Megestrol for anorexia/cachexia

Radiotherapy

• No prior radiotherapy
• No concurrent radiotherapy

Surgery

• See Disease Characteristics
• Prior attempt at resection or cytoreduction (e.g., debulking) surgery irrespective of surgical margins allowed provided there are no distant metastases
• At least 1 week but no more than 8 weeks since prior surgery and recovered

Other

• No other concurrent cytotoxic therapy
• No other concurrent antineoplastic therapy
• No other concurrent investigational therapy
• No concurrent medications known to prolong the QTc interval unless the medication can be held for at least 4 days during each treatment course