Медицинская литература. Новинки

 

 

 

 

 

 

Клинические рекомендации Европейской тиреоидологической ассоциации по метастатическому медуллярному раку щитовидной железы

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Отдаленные метастазы являются главной причиной смерти пациентов с медуллярным раком щитовидной железы (МРЩЖ). Рекомендации сфокусированы на пациентах с отдаленными метастазами МРЩЖ. Составлен подробный протокол наблюдения пациентов с биохимическим или топическим подтверждением этого заболевания, отражены критерии эффективности лечения, включая местные и системные варианты лечения, основанные на результатах последних исследований. Пациенты с бессимптомным течением болезни с низкой степенью опухолевого поражения и стабильным течением заболевания имеют положительный прогноз после местного лечебного воздействия и должны постоянно наблюдаться через определенные регулярные промежутки времени. Обследование проводится каждые 6–12 мес или через более длинные интервалы в зависимости от времени удвоения кальцитонина крови и раковоэмбрионального антигена (РЭА). Пациенты с распространенным опухолевым поражением и прогрессированием заболевания должны получать системное лечение. Большой прогресс в лечении достигнут с началом использования таргетной терапии мультикиназными ингибиторами, но необходимы дальнейшие исследования по улучшению результатов лечения

Ключевые слова:
медуллярный рак щитовидной железы, метастазы, ингибиторы тирозин
киназы, RET.

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2012 European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer

Distant metastases are the main cause of death in patients with medullary thyroid cancer (MTC). These 21 recommendations focus on MTC patients with distant metastases and a detailed followup protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials. Asymptomatic patients with low tumor burden and stable disease may benefit from local treatment modalities and can be followed up at regular intervals of time. Imaging is usually performed every 612 months, or at longer intervals of time depending on the doubling times of serum calcitonin and carcinoembryonic antigen levels. Patients with symptoms, large tumor burden and progression on imaging should receive systemic treatment. Indeed, major progress has recently been achieved with novel targeted therapies using kinase inhibitors directed against RET and VEGFR, but further research is needed to improve the outcome of these patients

Keywords:
medullary thyroid cancer, metastases, tyrosine kinase inhibitors, RET.