This protocol applies to non-metastatic anaplastic thyroid cancer (stage IVA or IVB) in patients with good performance status whose disease remains unresectable — or was resected with grossly positive margins (R2) — after a first-line treatment course.
Anaplastic thyroid cancer, stage IVA or IVB; unresectable disease or R2 (grossly positive margin) resection; no distant metastatic disease; good performance status.
First-line therapy — standard fractionation intensity-modulated radiotherapy (IMRT) with concurrent systemic cytotoxic chemotherapy, or (for BRAFV600E-mutated disease) combined BRAF/MEK inhibitors — aimed to reduce tumour volume and render the tumour potentially resectable. This protocol is indicated when those goals were not reached.
DOI: 10.1089/thy.2020.0944
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.
In patients with unresectable disease during initial evaluation in whom radiotherapy and/or systemic (chemotherapy or combined BRAF/MEK inhibitors) therapy render the tumor potentially resectable, we recommend reconsideration of surgical resection.