부산대학교 도서관

As more than 90% of all differentiated thyroid cancers can be cured with multimodal treatment, the prognosis with regard to freedom from recurrence and long-term survival is excellent. The decision regarding the treatment concept for patients with radioiodine-refractory (and mostly FDG-PET/CT-positive) recurrence and/or metastases must be made by the interdisciplinary tumor board. The lack of scintigraphic evidence of radioiodine uptake into one or all locoregional tumor manifestations or distant metastases does not justify initiation of systemic treatment in metastatic thyroid cancer. Only evidence of clinical progression (increase in size of metastases, involvement of additional compartments or organs) of radioiodine-refractory tumor manifestations and the patientʼs symptomatology provide a basis for initiating treatment with tyrosine kinase inhibitors (TKIs). Other factors to be considered are the location of metastases, tumor metabolism on FDG-PET/CT, biological patient age, comorbidities, and the feasibility of using locally effective treatment modalities. In clinically relevant progression of radioiodine-refractory thyroid cancer, first-line therapy with TKIs should be offered. In particular, lenvatinib and cabozantinib show high efficacy in terms of tumor control with frequent, although well-controllable, toxicity profiles. Early molecular tumor profiling may justify the use of selective inhibitors of BRAF, MEK, RET, or TRK in this patient population.