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DOI: 10.1055/s-0035-1547650
Protocol for the multimodal treatment of undifferentiated (anaplastic) thyroid carcinoma
Undifferentiated (anaplastic) thyroid carcinoma (UTC) is a very rare and aggressive disease with a median survival of about 6 months. There is no evidence-based therapy leading to improved overall survival. UTC treatment requires close interdisciplinary cooperation and is often highly variable depending on site-specific preferences.
The aim of our multidisciplinary initiative is to offer a treatment protocol for Germany, which can be implemented immediately and allows standardized acute UTC therapy with acceptable toxicity.
Initially, when UTC is suspected or confirmed histologically, imaging is performed (neck ultrasonography, CT scan of chest, neck and abdomen – ideally as FDG PET/CT) to assess the extent of disease. In addition, specimen will be send for a central pathology review including molecular profiling to the Institute of Pathology in Essen. Depending on a R0/R1 resection or an inoperable situation (extrathyroidal spread with infiltration of the aregodigestive tract) [1], the patient is offered a combined chemoradiotherapy. Depending on the results of subsequent imaging the therapeutic decision is made between i) the surgical therapy in an initially unresectable UTC, ii) continuation of chemotherapy in higher doses or iii) switch to targeted therapy in consultation with a thyroid cancer centre. In case of progressive disease, the option of a phase I trial will be discussed.
In summary, the development of a UTC protocol, will contribute to harmonize the previously heterogeneous thyroid cancer therapies in Germany and will support, by "UTC Awareness" and a better understanding of tumour biology, an improved treatment and ultimately also the prognosis of UTC patients.
[1] German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A; German Societies of General and Visceral Surgery; Endocrinology; Nuclear Medicine; Pathology; Radiooncology; Oncological Hematology; Ohne Schilddrüse leben e.V. Langenbecks Arch Surg. 2013 Mar;398(3):347 – 75