ATA Guidelines Tools

6 Treatment Î In patients with extrathyroidal invasion, an en bloc resection should be considered if grossly negative margins (R1 resection) can be achieved. (S-M) Î If preoperative staging and primary tumor assessment define the tumor extent as precluding safe or effective surgical resection, neoadjuvant external beam radiotherapy and/or chemotherapy should be considered to permit delayed primary surgical resection. (S-M) Î A comprehensive multimodality management plan should be rapidly formulated and implemented by a multidisciplinary thyroid cancer management team. (S-L) Î A total lobectomy or total or near-total thyroidectomy should be performed in most patients with an incidental area of ATC within a differentiated thyroid carcinoma (DTC). This is based primarily on treatment recommendations related to the non-anaplastic component of the malignancy. (S-L) Î The data are inadequate to definitively recommend either for or against local or systemic adjuvant therapy for small, intrathyroidal ATCs. A majority of the authors would favor cautious observation with frequent anatomic imaging studies for at least the first year of follow- up, while a minority would recommend adjuvant therapy. (W-L) Î Every attempt should be made to identify the contralateral recurrent laryngeal nerve, especially if the ipsilateral nerve is paralyzed, to protect the nerve from injury, which may lead to bilateral vocal cord paralysis and requirement for tracheostomy. A nerve monitor may be quite helpful to confirm nerve function. (S-L) Î Patients with ATC may require tracheostomy to avoid asphyxia. It should be done in an operating room setting, unless acute airway distress demands immediate action. (S-L) Î The patient's airway should be closely monitored in the recovery room during the postoperative period and throughout radiation therapy. Elective tracheostomy is best avoided unless there are acute airway issues. (S-L) Î Tracheostomy may be temporarily beneficial in patients with impending airway loss. (S-L) Î Tracheostomy or stent placement is best avoided unless there is impending airway compromise. (S-L) Radiotherapy and Systemic Chemotherapy in Locoregional ATC Î Following an R0 or R1 resection (excluding an incidental intrathyroidal microscopic lesion), patients with good performance status with no evidence of metastatic disease who wish an aggressive approach should be offered definitive radiation therapy (with or without concurrent chemotherapy). (S-M)

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