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J.Jpn. Surg. Soc.. 118(6): 610-615, 2017
Since 2014, the administration of tyrosine-kinase inhibitors (TKIs) has become a new line of therapy for thyroid carcinoma that does not respond to any other chemotherapy regimen. The indications for TKI treatment in differentiated thyroid carcinoma, which comprises most cases of thyroid carcinoma, are limited to radioactive iodine-refractory and/or unresectable lesions showing rapid progression. Recently, therapies using TKIs for unresectable anaplastic thyroid carcinoma and unresectable medullary thyroid carcinoma have also become available. However, TKIs are often associated with severe adverse events and affect patient quality of life. Therefore, TKIs should be administered only when thyroid carcinoma cannot be controlled by other agents after carefully considering the therapeutic risks and benefits.
At present, the first choice of therapy for any type of thyroid carcinoma is surgical management. TKIs are not a replacement for surgery, and surgeons should attempt the previously established resection procedures. In addition, preoperative treatment and postoperative adjuvant therapy with TKIs have not yet been established. Although the results of future clinical studies are awaited, TKIs are not currently recommended as preoperative or postoperative adjuvant treatment in thyroid carcinoma.
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