What are the guidelines on the treatment of anaplastic thyroid cancer?

Updated: Jun 24, 2020
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Answer

Answer

No curative treatment currently exists for anaplastic thyroid cancer (ATC). The majority of patients present with unresectable or metastatic disease.  NCCN guidelines recommend attempting total thyroidectomy in patients with resectable disease. [5]

ESMO guidelines note that incomplete palliative resection (R2) or ‘debulking‘ does not affect prognosis and is not recommended. Complete or near-complete (R0 or R1) resection followed by high-dose EBRT, with or without concomitant chemotherapy, provides optimal local disease control. For best outcomes, postoperative radiotherapy must be delivered as soon as possible after surgery. IMRT is the recommended approach. [6]

ATA guidelines recommend total lobectomy or total or near-total thyroidectomy with a therapeutic lymph node dissection for patients with intrathyroidal ATC. In patients with extrathyroidal invasion, an en bloc resection should be considered if grossly negative margins (R1 resection) can be achieved. [3] Both the NCCN and ATA guidelines recommend adjuvant radiation therapy, chemotherapy, or both. [3, 5]


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