Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma

Shereen Ezzat; Jesse D Pasternak; Murali Rajaraman; Omar Abdel-Rahman; Andrée Boucher; Nicole G Chau; Shirley Chen; Sabrina Gill; Martin D Hyrcza; Nathan Lamond; Marie-Hélène Massicotte; Eric Winquist; Ozgur Mete

doi:10.3389/fonc.2024.1437360

Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma

Front Oncol. 2024 Nov 4:14:1437360. doi: 10.3389/fonc.2024.1437360. eCollection 2024.

Authors

Affiliations

¹ Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON, Canada.
² Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
³ Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada.
⁴ Department of Oncology, University of Alberta, Edmonton, AB, Canada.
⁵ Endocrinology Division, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
⁶ Division of Medical Oncology, British Columbia Cancer - Vancouver, Vancouver, BC, Canada.
⁷ Division of Endocrinology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁸ Department of Pathology and Laboratory Medicine, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.
⁹ Division of Medical Oncology, Nova Scotia Cancer Centre, Halifax, NS, Canada.
¹⁰ Division of Endocrinology, Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.
¹¹ Verspeeten Family Cancer Centre at London Health Sciences Centre, London, ON, Canada.
¹² Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, ON, Canada.

Abstract

Most follicular cell-derived differentiated thyroid carcinomas are regarded as low-risk neoplasms prompting conservative therapeutic management. Here, we provide consensus recommendations reached by a multidisciplinary group of endocrinologists, medical oncologists, pathologists, radiation oncology specialists, a surgeon and a medication reimbursement specialist, addressing more challenging forms of this malignancy, focused on radioactive iodine (RAI)-resistant or -refractory differentiated thyroid carcinoma (RAIRTC). In this document we highlight clinical, radiographic, and molecular features providing the basis for these management plans. We distinguish differentiated thyroid cancers associated with more aggressive behavior from thyroid cancers manifesting as poorly differentiated and/or anaplastic carcinomas. Treatment algorithms based on risk-benefit assessments of different multimodal therapy approaches are also discussed. Given the scarcity of data supporting management of this rare yet aggressive disease entity, these consensus recommendations provide much needed guidance for multidisciplinary teams to optimally manage RAIRTC.

Keywords: molecular diagnosis; multidisciplinary; radioiodine-refractory differentiated thyroid cancer; targeted therapy; thyroid cancer.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Unrestricted funding for the research and development of these guidelines was provided by Bayer Inc. Bayer Inc. reviewed the manuscript for scientific accuracy but had no involvement in its content.