**13. Surveillance and follow up**

Active surveillance for those who had a complete response to initial treatment is needed. CT of the chest is done within 4 weeks and a single PET–CT is done after 3 months of treatment [15].


#### **Table 5.**

*Ongoing trials in ATC [3].*

CT of the neck/chest/abdomen is done thereafter every 1–3 months for the initial 2 years. Later on, less frequent imaging is recommended. Brain imaging is not routinely done, except in case of symptoms of brain metastasis.

There is no role for radioiodine scanning/ablation or serum thyroglobulin measurement.

Thyroid hormone replacement is required for maintaining euthyroid status. T4 should be started (1.6 mcg/kg body weight) immediately after surgery. TSH suppression to less than normal is not indicated in ATC.

## **14. Conclusion**

ATC is a rare thyroid malignancy with an extremely grave prognosis. Diagnosis and treatment should be started quickly and should be based on a multidisciplinary approach, including surgery, radiation, chemotherapy, and targeted agents. Stage IVA tumors should undergo primary surgery with gross-negative margins. For completely resected tumors, there is no role for additional therapies. For resectable stage IVB, surgery followed by adjuvant radiation with or without chemotherapy is recommended. For unresectable tumors, mutation-directed therapies based on BRAF mutation are to be incorporated followed by surgery or radiation. For Stage IVC, palliative treatment is recommended with either palliative radiation or debulking with or without systemic therapies. Although newer mutation-directed therapies are being incorporated into the management of ATC, further validation is needed. The inclusion of novel approaches, such as targeted therapy and immunotherapy either alone or in combination with other modalities, may improve outcomes in these patients.

*Approach and Management of Anaplastic Carcinoma Thyroid DOI: http://dx.doi.org/10.5772/intechopen.106463*
