ATA Guidelines Tools

9 Î Neurologically asymptomatic patients with brain metastases do not routinely require exogenous corticosteroid administration. Patients with neurologic brain compressive symptoms or signs should preferably receive dexamethasone (or alternatively a glucocorticoid equivalent) at appropriate doses. Individual patient considerations should apply with regard to the initiation, dose, and duration of exogenous corticosteroid administration. (S-M) Î It is not recommended that patients with brain metastases from ATC routinely receive prophylactic antiseizure medications. (W-L) Bone Metastases Î Patients with ATC who during the course of monitoring and treatment have skeletal symptoms, such as pain or pathologic fracture, should have radiologic evaluation of the specific area of concern. If there is proven osseous metastasis at a single specific site, radiologic evaluation of the skeleton may be performed to identify other sites of bony metastases. (S-L) Î It is reasonable to treat osseous metastases from ATC in a comparable manner to patients with other aggressive tumors causing osseous metastases with emphasis on radiotherapy and/or surgery. Metastatic lesions to the bone should be considered for palliative radiotherapy. If the lesions are in a weight-bearing region, orthopedic fixation should be considered prior to initiation of palliative radiotherapy. (S-L) Î Patients with known osseous metastases from ATC should be considered for periodic intravenous bisphosphonate infusions or subcutaneous RANK ligand inhibitor. Given the lack of data, it is not possible to make a definitive recommendation regarding the frequency and duration of these treatments. (W-L) Other Sites of Metastases Î A definitive recommendation regarding cryoablation, radiofrequency ablation, and selective embolization in patients with ATC cannot be made. (W-I) Î Tumor invasion into cervical veins can be diagnosed by CT, MRI, or venogram in the appropriate clinical context. There are insufficient data available to recommend either monitoring or a specific therapy such as surgery or radiation therapy for vascular tumor invasion. (W-L) ÎConsider prophylactic anticoagulation in patients who are at high risk for thromboembolic disease such as major surgery or receiving pertinent chemotherapy (specifically including thalidomide or lenalidomide). (S-M) Î Patients with documented venous thromboembolism should generally be treated with low molecular weight heparin with specific consideration of the individual context. (S-H)

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