Before starting treatment, a doctor will complete a full pre-treatment evaluation, which is outlined in previous sections. In general, there are 3 different options for the treatment of anaplastic thyroid cancer:
Surgery
Surgery plays a role in the treatment of anaplastic thyroid cancer; however, it is often limited by tumor size and invasion of surrounding structures at the time of diagnosis. In cases of ATC limited to the thyroid gland or with invasive disease that can be completely resected with minimal morbidity, then complete surgical excision with a total thyroidectomy is recommended.
Radiation
It is important to note that anaplastic thyroid cancer does not respond to radioactive iodine (RAI) which is generally beneficial to patients with well-differentiated thyroid cancer. External beam radiation therapy is therefore given following surgery (adjuvant) or as primary treatment in cases of unresectable or highly invasive disease. Radiation alone is less effective than when it is combined with chemotherapy. Therefore, radiation is typically given at the same time as a chemotherapeutic agent in patients that can tolerate this combined therapy.
Chemotherapy & Biologic Medications
Chemotherapy is not used alone for treatment of ATC, but has shown some limited success when combined with radiation therapy. The most common chemotherapy drugs given are cisplatin, doxorubicin, and paclitaxel, although other medications are under investigation. Other medications may be offered as part of a clinical trial, which is an investigative study assessing the effectiveness of a particular treatment. A clinical trial is an option for patients who are comfortable trying an experimental treatment. A medical care team consisting of several types of healthcare professionals will collaborate to determine the best and most up-to-date treatment for each patient.
Targeted Therapies
If a patient’s ATC is found to express the BRAF v600E mutation, then certain targeted therapies may be used. These therapies will be started right away, and will be continued for several months, as long as imaging scans demonstrate that there is a continued clinical response. The goal of these therapies is to shrink the tumor until it is small enough to be surgically removed, at which point surgery will be scheduled, followed by external beam radiation and conventional chemotherapy. Learn more about genetic and molecular testing.
Given the often rapid progression and overall guarded prognosis of ATC, palliative treatments meant to manage symptoms and provide comfort, rather than cure disease, should also be discussed in appropriate cases (such as patients with distant metastases).
