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53

NCCN Guidelines for Patients

®

:

Thyroid Cancer, Version 1.2017

5

Treatment guide

Papillary, follicular, and

Hürthle cell

Guide 18. Options for metastatic papillary, follicular, or Hürthle cell

When RAI therapy is not a treatment option

Disease status

Area of disease Next steps of care

Persistent

(continuing)

disease

or

Recurrent

disease in

the neck area

(local disease,

also called

locoregional)

or

Distant areas

of disease

(distant

metastases)

ª

• Persistent disease or

recurrent local disease

ª

• For disease that is growing or causing

symptoms:

• Lenvatinib or sorafenib

• Other kinase inhibitors (only for certain

people—not for slow-growing/stable

disease with other treatment options)

• Surgery for distant areas, and/or radiation

therapy (EBRT/SBRT/IMRT) to those

areas

• Local therapy (eg, ethanol ablation,

cryoablation, RFA)

ª

• Soft tissue metastases

(eg, lungs, liver,

muscle)

ª

• Bone metastases

ª

• Surgery, radiation (EBRT/SBRT), or local

therapy to relieve symptoms

• Block the blood vessels that feed the

growing cancer (embolization)

• IV (

i

ntra

v

enous) bisphosphonate or

denosumab

• For disease that is growing or causing

symptoms:

• Lenvatinib or sorafenib

• Other kinase inhibitors (only for certain

people—not for slow-growing/stable

disease with other treatment options)

• CNS (

c

entral

n

ervous

s

ystem- brain

and spinal cord)

metastases

ª

• Depends on single or multiple tumors,

growing disease, and symptoms:

• Surgery

• Radiation therapy (EBRT/IMRT)

• Stereotactic radiosurgery

• Lenvatinib or sorafenib

• Other kinase inhibitors (only for certain

people—not for slow-growing/stable

disease with other treatment options)

ª

For this disease status:

• Continue levothyroxine to keep TSH low or normal

• RAI therapy is not an option and chemotherapy may have little effect on this type of cancer

• Surveillance may be an option when disease is slow growing and not causing symptoms

• Clinical trials may be an option, ask your treatment team