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Anaplastic Thyroid Cancer

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Key Points Î Patients who present with a rapidly expanding neck mass require rapid histopathologic confirmation of the diagnosis. Î If anaplastic thyroid carcinoma (ATC) is diagnosed, the patient's overall clinical status and TNM stage of the tumor should be determined. Î Treatment goals (aggressive versus supportive care) should be established by disclosing the status and risks/benefits, discussing the patient's values and preferences, and then having the patient make an informed decision. Î Patients with stage IVA/IVB resectable disease have the best long-term survival, particularly if a multimodal approach (surgery, intensity- modulated radiation therapy [IMRT] for locoregional control, and systemic therapy) is used. Î Patients with unresectable stage IVB disease may also respond to aggressive multimodal therapy. Î Patients with distant metastases (stage IVC) only rarely have responded to traditional therapies, and if an aggressive approach is desired by the patient, a clinical trial should be considered. Î Hospice or palliative care is also an important component of managing patients with stage IVC disease. Table 1. Recommendation Grading Grade Rating Rating Definition Strength of Recommendation S Strong Benefits clearly outweigh risks and burden, or risks and burden clearly outweigh benefits W Weak Benefits finely balanced with risks and burden N None Insufficient evidence to determine net benefits or risks Quality of Evidence H High Requires one or more randomized, controlled trials without important limitations, or overwhelming evidence from observational studies M Moderate Derived from trials with important limitations, or exceptionally strong observational studies L Low Supported only by observational studies or case series I Insufficient for grading Evidence is lacking, of poor quality, or conflicting Adapted from: Qaseem A. Ann Intern Med 2010;153:194–199.

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