This protocol addresses anaplastic thyroid cancer (ATC) at stage IVA or IVB where the disease is either unresectable or has been resected with grossly positive margins (R2). There is no distant metastatic spread, and the patient is in good performance status — the profile in which an aggressive locoregional approach is appropriate.
Patients with unresectable or R2-resected ATC who remain free of distant metastasis and maintain good performance status represent a subgroup for whom intensive combined-modality therapy may offer meaningful locoregional control. Disease stage, resection margin status, and performance status together define the therapeutic decision point.
For patients in this scenario, guideline recommendations centre on locoregional radiotherapy delivered with concurrent systemic therapy. Depending on molecular testing results, a different targeted strategy may also be considered. The complete regimen, sequencing criteria, and all decision points are contained in the full protocol.
We recommend that patients who have undergone R2 resection or have unresectable but nonmetastatic disease with good performance status and who wish an aggressive approach be offered standard fractionation IMRT with systemic therapy.
Alternatively, in BRAFV600E-mutated ATC, combined BRAF/MEK inhibitors can be considered in this context.
Among patients who are to receive radiotherapy for unresectable thyroid cancer or in the postoperative setting, IMRT is recommended.
DOI: 10.1089/thy.2020.0944
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