2012 European thyroid association guidelines for metastatic medullary thyroid cancer.
Distant metastases are the main cause of death in patients with medullary thyroid cancer (MTC). These 21 recommendations focus on MTC patients with distant metastases and a detailed follow-up protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials. Asymptomatic patients with low tumor burden and stable disease may benefit from local treatment modalities and can be followed up at regular intervals of time. Imaging is usually performed every 6-12 months, or at longer intervals of time depending on the doubling times of serum calcitonin and carcinoembryonic antigen levels. Patients with symptoms, large tumor burden and progression on imaging should receive systemic treatment. Indeed, major progress has recently been achieved with novel targeted therapies using kinase inhibitors directed against RET and VEGFR, but further research is needed to improve the outcome of these patients.
Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave-Roussy and University Paris Sud, Villejuif, France.
M
M
Schlumberger
Department of Oncology, Odense University Hospital, Odense, Denmark.
L
L
Bastholt
Department of Surgery, Martin Luther University, Halle-Wittenberg Medical Faculty, Halle/Saale, Germany.
H
H
Dralle
MSC Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.
B
B
Jarzab
Department of Endocrinologia, University of Siena, Siena, Italy.
F
F
Pacini
Department of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands.
J W A
JW
Smit
Medullary thyroid cancer; Metastases; Rearranged during transfection mutation; Tyrosine kinase inhibitors