title: American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer.
abstract: BACKGROUND
  Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC.
  
  
  METHODS
  Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop.
  
  
  RESULTS
  The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations.
  
  
  CONCLUSIONS
  These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.
authors.affiliation: Mayo Clinic, Jacksonville, Florida 32224, USA. smallridge.robert@mayo.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smallridge
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Ain
authors.forename: Sylvia L
authors.initials: SL
authors.lastname: Asa
authors.forename: Keith C
authors.initials: KC
authors.lastname: Bible
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Burman
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.forename: Yuri E
authors.initials: YE
authors.lastname: Nikiforov
authors.forename: M Sara
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Shah
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
mesh_terms: D006801:Humans; D011379:Prognosis; D065646:Thyroid Carcinoma, Anaplastic; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*