ATA Guidelines Tools

7 Î Treatment should be planned and radiation started as soon as the patient is sufficiently recovered from neck surgery, usually within 2-3 weeks after surgery. (S-L) Î Systemic chemotherapy can begin as soon as the patient is sufficiently recovered from surgery, potentially even within 1 week of surgery, depending upon postoperative course and treatment goals. (S-L) Î Patients who have undergone R2 resection or have unresected disease with good performance status and who wish an aggressive approach should be offered definitive radiation (with or without concurrent chemotherapy). (S-M) Î Surgical resection may be reconsidered in patients when radiation (with or without chemotherapy) renders the tumor potentially resectable. (S-L) Î Patients with local symptoms and poor performance status should be offered palliative radiotherapy. (S-L) Î Patients who are to receive radiation for unresectable thyroid cancer or in the postoperative setting should, where available, be treated with IMRT. However, treatment should not be delayed because of lack of availability of IMRT. (S-L) Î The use of cytotoxic chemotherapy involving some combination of taxane (paclitaxel or docetaxel), and/or anthracyclines (doxorubicin) and/or platin (cisplatin or carboplatin) therapy should be considered in combination with radiation therapy or altered fractionated radiotherapy in good performance status patients with nonmetastatic ATC who desire aggressive therapy. (S-M) Supportive Care During Active Therapy Î In the absence of impending airway compromise, minor airway-related issues can be overcome with humidity, rest, and occasional use of short-term corticosteroids. (S-L) Î If the patient with ATC has difficulty swallowing and treatment with surgery, radiation, or chemoradiation therapy is planned, gastrostomy for enteral nutrition should be considered. (S-L) Î A percutaneous endoscopic gastrostomy tube may be difficult to place if the patient has involvement or obstruction of the esophagus. A percutaneous radiologically directed gastrostomy may be indicated in these patients. (S-L) Î Total parenteral nutrition is rarely necessary in patients with ATC. (S-L)

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