Background: The anaplastic thyroid carcinoma is an aggressive malignant tumor with median overall survival about 6 months. We analyzed the role of radiotherapy in the treatment of ATC and results of trimodal therapy (surgery, radiotherapy, chemotherapy). Methods: It is a retrospective analysis of all patients, who presented with histologically proven ATC at our centre between 1989 and 2008. We registered e.g. TNM-stadium, kind of surgery and radiotherapy. Results: 97.5% received radiation, 80% underwent surgery. At initial presentation in 25% of all distant metastasis were present. The median overall survival was 5 months. Conclusions: Although as expected prognosis of patients with anaplastic thyroid carcinoma is quite bad in our analysis, too, there have been cases of long term survival. Independent predictors of higher overall survival are absence of lymphnodemetastasis (N0), median dosis of radiation of 50 Gy or more and surgery. Anyway in future new therapeutic approachs targeting molecular processes should be investigated more intensively in large series to improve the prognosis of ATC.