{"id":4496,"date":"2022-01-26T15:38:21","date_gmt":"2022-01-26T20:38:21","guid":{"rendered":"https:\/\/staging.tiro.flywheelsites.com\/recommendations\/atc\/systemic-therapy\/"},"modified":"2022-08-16T13:22:09","modified_gmt":"2022-08-16T18:22:09","slug":"systemic-therapy","status":"publish","type":"page","link":"https:\/\/tiro.expert\/es\/recommendations\/atc\/systemic-therapy\/","title":{"rendered":"Terapia sist\u00e9mica"},"content":{"rendered":"\t<style media=\"screen\">\n\t:root { --row-count: 4; }\n\t<\/style>\n<div class=\"clinical-outline-wrap open\">\n\t<div class=\"outline-header\">\n\t\t<p><strong>Systemic Therapy<\/strong><\/p>\t\t<p>Clinical Outline<\/p>\n\t<\/div>\n\n\t<div id=\"toc\">\n\t\t<div class=\"aod-opener opened\"><\/div>\n\t\t<div class=\"toc-content\"><\/div>\n\t<\/div>\n\n\t<div id=\"edu\" class=\"wp-block-group__inner-container legend\">\n\t\t<div class=\"aod-opener\"><\/div>\n\n\t\t<div class=\"table-wrap aod-content\">\n\t\t\t<div class=\"table-grid\">\n\n\t\t\t\t<div class=\"table-header table-row\">\n\t\t\t\t\t<div class=\"fixed-col\">Educational Clips from TIROxMDS<\/div>\n\n\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\" title=\"Primers in Thyroidology\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\" title=\"Journal Club Presentation\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\" title=\"Case-based Discussion (inc. roundtables)\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\" title=\"Grand Rounds Lectureship\"><\/i><\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">1. Systemic Therapies<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">A. Neoadjuvant Systemic Therapy<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">B. Bridging Chemotherapy<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">C. Concomitant Chemotherapy<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">2. Persistent or Unresectable Disease<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col lvl-2\"><a href=\"\">A. Radiation<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t<div id=\"key\" class=\"legend\">\n\t\t\t\t<div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Primers in Thyroidology<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Journal Club Presentation<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Case-based Discussion (inc. roundtables)<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Grand Rounds Lectureship<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t<\/div>\n\t<\/div>\n\n\t<div class='outline-tab closer'><i class='fas fa-times'><\/i><\/div>\n\n\t<div id=\"areas-discord\" class=\"legend cloak\">\n\t\t<div class=\"aod-opener\"><\/div>\n\t\t<div class=\"aod-content\"><\/div>\n\t<\/div>\n\t<div class=\"logo-wrap\">\n\t\t<div class=\"widget widget_media_image\"><div class=\"widget-content\"><a href=\"\/\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"250\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png\" class=\"image wp-image-1039  attachment-full size-full\" alt=\"TIRO Thyroid International Recommendations Online monogram logo\" style=\"max-width: 100%; height: auto;\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png 250w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269-150x150.png 150w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a><\/div><\/div>\t<\/div>\n\t<div class=\"site-nav\">\n\t\t<div class=\"menu-primary-tiro-container\"><ul id=\"menu-primary-tiro\" class=\"menu\"><li id=\"menu-item-3048\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-3048\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/\" data-ps2id-api=\"true\">Care Recommendations<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4432\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4432\"><a href=\"#\" data-ps2id-api=\"true\">Differentiated Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-1987\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1987\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-evaluation-of-thyroid-nodules\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules<\/a><\/li>\n\t\t<li id=\"menu-item-1986\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1986\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-management\/\" data-ps2id-api=\"true\">Initial Management<\/a><\/li>\n\t\t<li id=\"menu-item-1983\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1983\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-staging-response-to-therapy\/\" data-ps2id-api=\"true\">Initial Staging &#038; Response to Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1984\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1984\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1985\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1985\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/use-of-rai\/\" data-ps2id-api=\"true\">Use of Radioactive Iodine<\/a><\/li>\n\t\t<li id=\"menu-item-1982\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1982\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/recurrent-persistent-disease\/\" data-ps2id-api=\"true\">Recurrent &#038; Persistent Disease<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4433\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4433\"><a href=\"#\" data-ps2id-api=\"true\">Medullary Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4465\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4465\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/initial-evaluation-of-thyroid-nodules-suspicious-of-mtc\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules Suspicious of MTC<\/a><\/li>\n\t\t<li id=\"menu-item-4467\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4467\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4862\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4862\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/evaluation-of-advanced-disease\/\" data-ps2id-api=\"true\">Evaluation of Advanced Disease<\/a><\/li>\n\t\t<li id=\"menu-item-4466\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4466\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/management-of-specific-clinical-scenarios\/\" data-ps2id-api=\"true\">Management of Specific Clinical Scenarios<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4434\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4434\"><a href=\"#\" data-ps2id-api=\"true\">Anaplastic Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4502\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4502\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/diagnostic-procedures\/\" data-ps2id-api=\"true\">Diagnostic Procedures<\/a><\/li>\n\t\t<li id=\"menu-item-4501\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4501\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/initial-staging-treatment-planning\/\" data-ps2id-api=\"true\">Initial Staging &#038; Treatment Planning<\/a><\/li>\n\t\t<li id=\"menu-item-4500\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4500\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4499\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4499\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-4498\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4498\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/end-of-life-care\/\" data-ps2id-api=\"true\">End of Life Care<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-29263\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-29263\"><a href=\"#\" data-ps2id-api=\"true\">Analysis Tools<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-29264\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-29264\"><a href=\"https:\/\/tiro.expert\/es\/ata-2025-risk-of-recurrence-calculator\/\" data-ps2id-api=\"true\">Risk of Recurrence Calculator<\/a><\/li>\n\t\t<li id=\"menu-item-20846\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20846\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/analysis-tools\/\" data-ps2id-api=\"true\">Anatomic Checklist for Thyroid Cancer<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-1990\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1990\"><a href=\"https:\/\/tiro.expert\/es\/clinical-trial-options\/\" data-ps2id-api=\"true\">Clinical Trial Options<\/a><\/li>\n\t<li id=\"menu-item-3818\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3818\"><a href=\"https:\/\/tiro.expert\/es\/tables-and-figures\/\" data-ps2id-api=\"true\">Tables &#038; Figures<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1973\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1973\"><a href=\"#\" data-ps2id-api=\"true\">Events<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4348\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4348\"><a href=\"https:\/\/tiro.expert\/es\/webinars\/\" data-ps2id-api=\"true\">Upcoming Webinars<\/a><\/li>\n\t<li id=\"menu-item-20057\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20057\"><a href=\"https:\/\/tiro.expert\/es\/past-webinars\/\" data-ps2id-api=\"true\">Past Webinars<\/a><\/li>\n\t<li id=\"menu-item-1975\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1975\"><a href=\"\/subscribe\" data-ps2id-api=\"true\">Subscribe <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1974\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1974\"><a href=\"#\" data-ps2id-api=\"true\">About TIRO<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-1977\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1977\"><a href=\"https:\/\/tiro.expert\/es\/what-is-tiro\/\" data-ps2id-api=\"true\">What is TIRO?<\/a><\/li>\n\t<li id=\"menu-item-2407\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2407\"><a href=\"https:\/\/tiro.expert\/es\/how-to-use-tiro\/\" data-ps2id-api=\"true\">How to Use TIRO<\/a><\/li>\n\t<li id=\"menu-item-1978\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1978\"><a href=\"https:\/\/tiro.expert\/es\/contact\/\" data-ps2id-api=\"true\">Contact<\/a><\/li>\n\t<li id=\"menu-item-1979\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1979\"><a href=\"https:\/\/thancguide.org\/\" data-ps2id-api=\"true\">THANC Guide <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n\t<li id=\"menu-item-1980\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1980\"><a href=\"https:\/\/thancfoundation.org\" data-ps2id-api=\"true\">THANC Foundation <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div>\t<\/div>\n<\/div>\n<div class=\"clinical-outline-mask\"><\/div>\n\n\n\n<h2 class=\"has-secondary-color has-text-color wp-block-heading\">Management Recommendations<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1. Systemic Therapies<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Clinical trial enrollment should be encouraged for all patients diagnosed with ATC.<span id=\"cd7e4ef7-1891-4a58-8f96-ad5dd7873f5d\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Urgent assessment of <em>BRAF<sup>V600E<\/sup><\/em> mutation and extended molecular profiling is strongly recommended as it may identify potential targets for therapy.<span id=\"869c6b02-17ba-495a-bf5c-cb5d498bdc5b\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">A. Neoadjuvant Systemic Therapy<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">For stage IVA, IVB consider external beam radiotherapy (EBRT) preferably intensity modulated radiotherapy (IMRT) with concomitant chemotherapy when appropriate or molecularly targeted neoadjuvant therapy (for example dabrafenib\/trametinib for <em>BRAF<sup>V600E<\/sup><\/em> mutations; selpercatinib or pralsetinib for RET-Fusion positive tumours; and larotrectinib or entrectinib for patients with NTRK gene fusion-positive tumours).<span id=\"ef45e8b8-0964-4b13-bc59-f4e9ef8befee\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1,2\u200b<\/sup><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">B. Bridging Chemotherapy<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Among ATC patients with unresectable or advanced disease who wish to consider aggressive therapy, cytotoxic chemotherapy may be started as an initial and potentially bridging approach until mutational profiling results and\/or mutationally specified therapies become available.<span id=\"d7c179f6-a709-4338-b205-b40e3ce2aa20\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"cloak has-lightning-background-color has-background wp-block-paragraph\"><strong>EXPERT COMMENTARY OR EDUCATIONAL CONTENT : UPFRONT SHORT COURSE EBRT<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">C. Concomitant Chemotherapy<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">In BRAF nonmutated patients, radiation therapy with concurrent chemotherapy should be considered in an effort to maintain the airway in patients with low burden of metastatic disease.<span id=\"d532b3b0-0501-48e8-bf04-530228eaa4ed\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cytotoxic chemotherapy can usually be started within a week of surgery, provided sufficient healing, while subsequent chemoradiation is planned.<span id=\"de8efbd3-9691-4025-916d-b180146e786c\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The use of concomitant cytotoxic chemotherapy involving a Taxane (paclitaxel or docetaxel), or anthracyclines (doxorubicin) or platin (cisplatin or carboplatin), should be considered in patients treated with definitive intention radiation.<span id=\"0aebe998-c162-4cf4-9798-a3d54574075e\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;,&quot;3526447921&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2. Persistent or Unresectable Disease<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who have undergone R2 resection or have unresectable but nonmetastatic disease with good performance status can be offered standard fractionation IMRT with concomitant systemic therapy. In <em>BRAF<sup>V600E<\/sup><\/em>-mutated ATC, combined BRAF\/MEK inhibitors can be considered as an alternative.<span id=\"521be11d-fe90-4ca2-a055-287d5566c70c\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In <em>BRAF<sup>V600E<\/sup><\/em>-mutated IVC and in unresectable IVB ATC patients who decline radiation therapy, initiation of BRAF\/MEK inhibitors (dabrafenib plus trametinib) is recommended over other systemic therapies if available.<span id=\"e3791d27-bf9e-4efd-a2e1-6cd841a99445\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In NTRK or RET fusion ATC patients with stage IVC disease, it is advisable to initiate a TRK inhibitor (either larotrectinib or entrectinib) or RET inhibitor (either selpercatinib or pralsetinib), preferably in a clinical trial, if available.<span id=\"1773ece0-c88b-46bf-b5ba-0b1ce6a81688\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In IVC ATC patients with high PD-L1 expression, checkpoint (PD-L1, PD1) inhibitors can be considered first-line therapy in the absence of other actionable alterations or as later line therapy, preferably in the context of a clinical trial.<span id=\"82f502ba-334d-40cd-b67d-039682de4630\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In metastatic ATC patients lacking other therapeutic options including clinical trials, suggest considering cytotoxic chemotherapy including a taxane and\/or an anthracycline or taxane with or without cis- or carboplatin.<span id=\"a08570b2-1861-4cb1-833c-9538fb25a815\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;,&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In patients with ATC with bone metastasis, intravenous bisphosphonate infusions or subcutaneous RANK ligand inhibitor should be considered.<span id=\"dac4472c-eccd-48d8-9b92-6cd887f80a23\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">A. Radiation<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">For locally advanced disease, patients with R0\/R1 resections with minimal co-morbid illnesses and M0 disease, consider postoperative EBRT +\/- chemotherapy soon after the diagnosis is made.<span id=\"b4260f5b-a6a6-4a92-93a1-cd398e0bf28a\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;,&quot;3526447921&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For unresectable (R2\/M1), BRAF wild-type disease , palliative EBRT may be considered.<span id=\"dac6d6ed-82ba-47b4-a292-ea61bd0596c5\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Due to its rapid growth, accelerated fraction radiation has the potential to limit tumor growth that may occur during the course of radiation therapy.<span id=\"3c85de27-39c7-4682-a5ef-8bfb4de6e00f\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In general, preoperative radiation is&nbsp; not recommended.<span id=\"bc3c4f44-e81a-49d1-9702-a98ef168d639\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Following thyroidectomy, if&nbsp; anaplastic thyroid cancers are incidentally detected post-operative radiation therapy is not recommended.<span id=\"8ea168f3-74f7-426c-9443-1104e9236282\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lower-doses of radiotherapy may provide a&nbsp; palliative benefit for patients with poor performance status.<span id=\"952a759d-0ab8-43f0-bc8d-7dfa32cf5624\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span> Radiotherapy should be considered as&nbsp; palliative treatment for bone metastases, spinal cord compression, brain metastases<span id=\"41494dd0-3e3b-41c4-9330-7c55d9e5e1d7\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;1400531341&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u20133\u200b<\/sup><\/span> and post obstructive pneumonia and hemoptysis due to endobronchial lesions.<span id=\"0a748158-a1db-4822-b6fa-ed2ef4bace1a\" data-items=\"[&quot;3554851309&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span><\/p>\n\n\n\n<div class=\"wp-block-media-text alignwide is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded has-violet-08-color has-subtle-background-background-color has-text-color has-background tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:30% auto\"><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg);background-position:67% 52%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg\" alt=\"selective focus photography of people sitting on chairs while writing on notebooks\" class=\"wp-image-2444 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi.jpg 1600w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-violet-08-color has-text-color\">Add TIROxMDS Webinars to Your Calendar<\/h2>\n\n\n\n<p class=\"has-violet-08-color has-text-color wp-block-paragraph\"><strong>In 2 quick steps, you can add our entire schedule of upcoming webinars to your calendar today!<\/strong> That way, you will never miss our upcoming lectures, presentations and case-based studies. Every Friday at 8:00 AM ET, we cover a new topic from published research.<\/p>\n\n\n\n<a title=\"Add to Calendar\" class=\"addeventstc\" data-id=\"wo408159\" href=\"https:\/\/www.addevent.com\/calendar\/wo408159\" target=\"_blank\" rel=\"nofollow noopener\">Add to Calendar<\/a>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center tw-mb-6 tw-sm-text-left tw-heading-border-bottom has-violet-color has-text-color has-h-3-font-size\">Upcoming Webinars<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<div class=\"wp-block-columns alignwide tw-mt-8 tiroxmds-grid tw-cols-rounded tw-cols-stack-md tw-cols-card tw-cols-card-white is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Ari Wassner, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Thyroid Function After Hemithyroidectomy in Children<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 13, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/7l5nwlyqyxsl\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Gabriela Brenta, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>ATA 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy &amp; Post Partum<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 20, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/r2zbrqhwblsp\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column has-accent-background-color has-background is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-violet-04-color has-text-color has-h-5-font-size\">No Webinar<\/h3>\n\n\n\n<p class=\"has-background-color has-text-color has-small-font-size wp-block-paragraph\"><strong><strong>Due to Thanksgiving (US Holiday).<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date has-violet-05-color has-text-color wp-block-paragraph\">Nov. 27, 2026<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignwide has-media-on-the-right is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:auto 49%\"><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-text-align-center has-violet-08-color has-text-color\">Watch Past Videos<\/h2>\n\n\n\n<p class=\"has-text-align-center has-violet-08-color has-text-color wp-block-paragraph\">We record and post all prior educational webinars to our YouTube channel.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-cbcdc57d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--2\"><a class=\"wp-block-button__link has-violet-color has-white-background-color has-text-color has-background has-link-color has-border-color wp-element-button\" href=\"https:\/\/youtube.com\/playlist?list=PLKIn9wjqDMOm0DCLhGQN77tnT4MPo_Rcg\" style=\"border-color:#5b47da;border-width:3px;border-radius:100px\" target=\"_blank\" rel=\"noreferrer noopener\">Watch now<\/a><\/div>\n<\/div>\n<\/div><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg);background-position:55% 34%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg\" alt=\"Focused businessman wear headphones study online watching webinar\" class=\"wp-image-1180 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-scaled.jpg 2048w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1980x1320.jpg 1980w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-group tw-rounded has-blush-light-purple-gradient-background has-background\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">\u00cates-vous de langue maternelle fran\u00e7aise?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Notre conseil consultatif international a cr\u00e9\u00e9 une version portable de TIRO.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/04\/TIRO.expert-Traduction-en-francais-des-recommandations.docx.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-cloud-arrow-down\"><\/i> t\u00e9l\u00e9charger le PDF<\/a><\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-subtle-background-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group tw-mt-0 tw-mb-0\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<section aria-label=\"Bibliography\" class=\"wp-block-abt-bibliography abt-bibliography\" role=\"region\"><h3 class=\"abt-bibliography__heading\">References<\/h3><ol class=\"abt-bibliography__body\" data-entryspacing=\"1\" data-maxoffset=\"3\" data-linespacing=\"1\" data-second-field-align=\"flush\"><li id=\"3554851309\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">1. <\/div><div class=\"csl-right-inline\">Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. <i>Thyroid<\/i>. Published online January 2016:1-133. doi:<a href=\"https:\/\/doi.org\/10.1089\/thy.2015.0020\">10.1089\/thy.2015.0020<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1033354911\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">2. <\/div><div class=\"csl-right-inline\">Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. <i>J Natl Compr Canc Netw<\/i>. Published online December 2018:1429-1440. doi:<a href=\"https:\/\/doi.org\/10.6004\/jnccn.2018.0089\">10.6004\/jnccn.2018.0089<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1400531341\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">3. <\/div><div class=\"csl-right-inline\">Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. <i>Annals of Oncology<\/i>. Published online December 2019:1856-1883. doi:<a href=\"https:\/\/doi.org\/10.1093\/annonc\/mdz400\">10.1093\/annonc\/mdz400<\/a><\/div>\n  <\/div>\n<\/li><li id=\"3526447921\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">4. <\/div><div class=\"csl-right-inline\">Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. <i>Endocr J<\/i>. Published online 2020:669-717. doi:<a href=\"https:\/\/doi.org\/10.1507\/endocrj.ej20-0025\">10.1507\/endocrj.ej20-0025<\/a><\/div>\n  <\/div>\n<\/li><\/ol><\/section>\n<\/div><\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recomendaciones de manejo 1. Terapias sist\u00e9micas Terapias sist\u00e9micas Debe fomentarse la inscripci\u00f3n en ensayos cl\u00ednicos para todos los pacientes diagnosticados de ATC.1-3 Se recomienda encarecidamente la evaluaci\u00f3n urgente de la mutaci\u00f3n BRAFV600E y la elaboraci\u00f3n de perfiles moleculares ampliados, ya que pueden identificar posibles objetivos para la terapia.1-3 A. Terapia sist\u00e9mica neoadyuvante Para los estadios IVA, IVB, considere la radioterapia de haz externo (EBRT), preferiblemente la radioterapia de intensidad modulada (IMRT)...<\/p>","protected":false},"author":1,"featured_media":4689,"parent":4463,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/template-cover.php","meta":{"_acf_changed":false,"inline_featured_image":false,"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-4496","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO Pro 5.0.5 - aioseo.com -->\n\t<meta name=\"description\" content=\"Considering adjuvant treatment can help improve a patient&#039;s prognosis. 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