Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for persist

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for persistent/recurrent and metastatic differentiated

thyroid cancer 2018 (English version)

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for persistent/recurrent and metastatic differentiated thyroid cancer working group

【期刊名称】中国癌症研究（英文版） 【年(卷),期】2019(031)001 【总页数】18

View this article at:https://doi.org/10.21147/j.issn.1000-9604.2019.01.06

Contents

1. Diagnosis and dynamic assessment of persistent/recurrent and metastatic differentiated thyroid cancer (prmDTC) 1.1 Basic principles of diagnosis 1.2 Diagnostic methods

1.3 Ongoing assessment of response to therapy 2. Multidisciplinary treatment of prmDTC 2.1 Basic principles of treatment 2.2 Surgical management

2.2.1 Preoperative clinical assessment

2.2.2 Principles of surgical treatment for prmDTC

2.3 131I therapy

2.3.1 Clinical assessment before 131I therapy 2.3.2 Management of 131I therapy for prmDTC 2.4 TSH suppression therapy

2.4.1 Strategy for TSH suppression therapy

2.4.2 Management of adverse effects of TSH suppression therapy 2.5 External beam radiation therapy 2.6 Systemic therapy

1. Diagnosis and dynamic assessment of persistent/recurrent and metastatic differentiated thyroid cancer (prmDTC)

Differentiated thyroid cancer (DTC), including papillary,follicular and Hürthle cell types, accounts for nearly 95%of all thyroid carcinomas. The concept of DTC recurrence or persistence after surgery is still difficult to define due to its indolent nature. The recurrent or persistent tumors in this guideline refer to new lesions or residual tumors found during the follow-up after initial treatments. 1.1 Basic principles of diagnosis

The role of multidisciplinary team (MDT) should be emphasized during the diagnosis of prmDTC. A task force of specialists with complementary expertise

(endocrinology,surgery,

nuclear

medicine,

radiology,

pathology, oncology,molecular diagnostics, and epidemiology) should be included in the MDT management of prmDTC. The diagnosis or

further managements of prmDTC which may include surgical managment,

radioiodine-131

(131I)

therapy,thyroid

stimulating

hormone (TSH) suppressive therapy, as well as molecular targeted therapy (or being enrolled in certain clinical trial) or radiation therapy, etc., should be tailored according to comprehensive consideration of MDT.

1.2 Diagnostic methods

Laboratory tests, imaging studies and pathological examinations are recommended in the diagnosis of prmDTC (Table 1). 1.3 Ongoing assessment of response to therapy (Table 2)

As the risk of recurrence and cancer-related death in prmDTC may change over time, life long follow-up and periodical surveillance including laboratory and imaging evaluation are needed. Ongoing assessment of response to therapy should be used to guide the long-term surveillance and therapeutic management decision. In this guideline, we adopted the system of response to therapy which was put forward by 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.

Multiple factors including clinical, biochemical, imaging(structural and functional) and cytopathology findings were taken into comprehensive consideration in this response system to assess the individual response