ATA Guidelines Tools

10 Treatment Î Serum levels of Ctn and CEA should be measured 3 months postoperatively, and if undetectable or within the normal range they should be measured every six months for 1 year and then yearly thereafter. (C) Î Patients with elevated postoperative serum Ctn levels <150 pg/mL should have a physical examination and US of the neck. If these studies are negative the patients should be followed with physical examinations, measurement of serum levels of Ctn and CEA, and US every 6 months. (C) Î If the postoperative serum Ctn level exceeds 150 pg/mL, patients should be evaluated by imaging procedures including neck US, chest CT, contrast-enhanced MRI or three-phase contrast-enhanced CT of the liver, bone scintigraphy, and MRI of the pelvis and axial skeleton. (C) Î In patients with detectable serum levels of Ctn and CEA following thyroidectomy, the levels of the markers should be measured at least every six months to determine their doubling times. (B) Î Surgical resection of persistent or recurrent loco-regional MTC in patients without distant metastases should include compartmental dissection of image-positive or biopsy-positive disease in the central (level VI) or lateral (levels II-V) neck compartments. Limited operative procedures, such as resection of only grossly metastatic lymph nodes, should be avoided unless there has been prior extensive surgery in a compartment. (C) Î Postoperative radioactive iodine (RAI) is not indicated following thyroidectomy for MTC. However, it should be considered in patients whose primary tumor and lymph node metastases contain MTC mixed with either PTC or follicular thyroid carcinoma. (E) Î Postoperative adjuvant EBRT to the neck and mediastinum should be considered in patients at high risk for local recurrence (microscopic or macroscopic residual MTC, extrathyroidal extension, or extensive lymph node metastases), and those at risk of airway obstruction. The potential benefits must be weighed against the acute and chronic toxicity associated with the therapy. (C). Î Systemic therapy should not be administered to patients who demonstrate increasing serum Ctn and CEA levels but have no documented metastatic disease. Nor should systemic therapy be administer to patients with stable low volume metastatic disease, as determined by imaging studies, serum Ctn, and CEA doubling times >2 years. (C)

• Cover