American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

American Thyroid Association Guidelines
for Management of Patients with Anaplastic Thyroid Cancer

Robert C. Smallridge,1,* Kenneth B. Ain,2,3 Sylvia L. Asa,4,5 Keith C. Bible,6 James D. Brierley,4,5 Kenneth D. Burman,7 Electron Kebebew,8 Nancy Y. Lee,9 Yuri E. Nikiforov,10 M. Sara Rosenthal,11 Manisha H. Shah,12 Ashok R. Shaha,9 and R. Michael Tuttle9

for the American Thyroid Association Anaplastic Thyroid Cancer Guidelines Taskforce

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC.

Methods: Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop.

Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations.

Conclusions: These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.

*Robert C. Smallridge, M.D., is Chair of the American Thyroid Association Anaplastic Thyroid Cancer Guidelines Taskforce. All authors after the first author are listed in alphabetical order.

1Mayo Clinic, Jacksonville, Florida.
2Veterans Affairs Medical Center, Lexington, Kentucky.
3University of Kentucky, Lexington, Kentucky.
4Princess Margaret Hospital, University Health Network, Toronto, Canada.
5University of Toronto, Toronto, Canada.
6Mayo Clinic, Rochester, Minnesota.
7Washington Hospital Center, Washington, District of Columbia.
8Endocrine Oncology Branch, National Cancer Institute, Bethesda, Maryland.
9Memorial Sloan-Kettering Cancer Center, New York, New York.
10
University of Pittsburgh, Pittsburgh, Pennsylvania.
11Program for Bioethics, University of Kentucky, Lexington, Kentucky.
12Ohio State University, Columbus, Ohio.

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer
(Full Text PDF File, 782 KB)

Supplementary Data 1 (PDF File, 84 KB)

Address correspondence to:
Robert C. Smallridge, M.D.
Mayo Clinic
4500 San Pablo Road
Jacksonville, FL, 32224
E-mail: smallridge.robert@mayo.edu