14
Radiotherapy and Systemic Chemotherapy in Locoregionally-
confined (Stages IVA and IVB) ATC: Principles and Approaches
Recommendation 14
➤ Following R0 or R1 resection, the ATA recommends that good
performance status patients with no evidence of metastatic disease
who wish an aggressive approach should be offered standard
fractionation IMRT with concurrent systemic therapy. (S-L)
Good Practice Statement 8
➤ Radiation therapy should begin no later than 6 weeks after surgery.
Good Practice Statement 9
➤ Patient goals of care, medical and psychosocial fitness for therapy,
potential toxicities, financial considerations, and robustness of social
support must be prominently considered in the decision to proceed
with aggressive multimodal therapy.
Good Practice Statement 10
➤ Cytotoxic chemotherapy can be initiated within 1 week of surgery,
providing sufficient healing, in anticipation of subsequent
chemoradiation.
Recommendation 15
➤ The ATA recommends 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 BRAF
V600E
-mutated ATC, combined BRAF/MEK inhibitors can be
considered in this context. (S-L)
Recommendation 16
➤ 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, the ATA
recommends reconsideration of surgical resection. (S-L)
Good Practice Statement 11
➤ In patients of poor performance status, palliative or preventative (no
residual disease present) locoregional radiotherapy over high dose
radiotherapy is suggested. (GPS)
Recommendation 17
➤ Among patients who are to receive radiotherapy for unresectable thyroid
cancer or in the postoperative setting, IMRT is recommended. (S-L)
Treatment
