Abstract
Thyroid cancer is a rare tumor, occurring in about 1 % of the population. DTC treatment requires a multidisciplinary approach involving close collaboration between the endocrinologist, surgeon, pathologist, nuclear medicine specialist, and oncologist.
DTCs are treated with surgical, radioactive iodine (RAI) and levothyroxine suppressive hormone therapy. Most patients with DTC have a very good prognosis.
However, if the DTC becomes refractory to radioiodine, then the prognosis is poor. In recent years, the knowledge of genetics has been significantly applied in targeted systemic treatment in clinical practice.
We now have the opportunity to influence the course of the disease in RAI-refractory patients using tyrosine kinase inhibitors (TKIs): sorafenib and lenvatinib in DTC and cabozantinib and vandetanib MTC. The multidisciplinary team addresses the issue of early timing of initiation of TKI, assesses the rate of disease progression and whether the tumor has reached the point of inflection: the size of the lesion has doubled within 1 year, and systemic treatment should be started immediately.
At present, we have in Czech Republic 6 centers for the treatment of locally advanced or metastatic thyroid carcinoma using TKI, which can be approached to provide comprehensive care for these patients.