title: Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma.
abstract: Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean overall survival has not improved in the past 50 years.
authors.affiliation: CIBERDEM Endocrinology and Nutrition Service, Hospital Universitario de Bellvitge, Spain. Electronic address: josemanuelgomezsaez@gmail.com.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Gómez Sáez
authors.affiliation: Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario de Cruces, Vizcaya, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Santamaría Sandi
authors.affiliation: Medical Oncology Service, Hospital Universitario de la Vall d́Hebron, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Capdevila Castillón
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Navarro González
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario de la Vall d́Hebron, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Zafón Llopis
authors.affiliation: Medical Oncology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ramón Y Cajal Asensio
authors.affiliation: Endocrinology and Nutrition Service, Hospital Universitario de Móstoles, Madrid, Spain.
authors.forename: Garcilaso
authors.initials: G
authors.lastname: Riesco Eizaguirre
authors.affiliation: Medical Oncology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Grande Pulido
authors.affiliation: Clínica Universidad de Navarra, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Galofré Ferrater
mesh_terms: D000465:Algorithms; D006801:Humans; D013030:Spain; D065646:Thyroid Carcinoma, Anaplastic / Q000628:therapy*; D013964:Thyroid Neoplasms / Q000628:therapy*
keywords: Adenopatías cervicales; Anaplastic thyroid carcinoma; Anomalías genéticas; Carcinoma anaplásico de tiroides; Carcinoma de tiroides poco diferenciado; Carcinoma diferenciado de tiroides; Cervical adenopathies; Differentiated thyroid carcinoma; Distant metastases; Genetic abnormalities; Metástasis a distancia; Poorly differentiated thyroid carcinoma