Precision Oncology and Advanced Thyroid Cancer: Integrating Surgery, Molecular Targeting, and Nuclear Medicine Across the Americas
DOI:
https://doi.org/10.64784/225Palabras clave:
Advanced thyroid cancer, Precision medicine, Molecular oncology, Targeted therapy, Endocrine surgery, Radioiodine-refractory thyroid cancer, Nuclear medicine, Molecular imaging, Genomic profiling, Tyrosine kinase inhibitors, BRAF mutation, RET alteration, Americas, Personalized treatment, Multidisciplinary careResumen
Advanced thyroid cancer remains a significant clinical challenge despite major advances in endocrine oncology. Although conventional management based on surgery and radioactive iodine therapy continues to provide favorable outcomes for many patients, locally advanced, recurrent, metastatic, and radioiodine-refractory disease often require more complex therapeutic approaches. The objective of this review was to analyze contemporary surgical innovations, molecular-targeted therapies, and nuclear medicine strategies used in the management of advanced thyroid cancer throughout the Americas. A narrative literature review was conducted using the Scientific Method as the methodological framework. Scientific evidence was retrieved from PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar, focusing on studies published between 2014 and 2026. The findings demonstrated that molecularly targeted therapies have become a central component of treatment, particularly in tumors harboring BRAF, RET, and NTRK alterations. Lenvatinib, sorafenib, cabozantinib, selpercatinib, pralsetinib, and dabrafenib-trametinib have significantly expanded therapeutic options for patients with advanced disease. Surgical intervention remains essential for local disease control and management of recurrent or invasive tumors, while nuclear medicine continues to play a critical role through radioactive iodine therapy, PET/CT, SPECT/CT, and emerging redifferentiation strategies. The review also identified important challenges related to molecular testing accessibility, targeted therapy availability, specialized surgical services, and nuclear medicine infrastructure across different healthcare systems. Overall, the evidence supports a transition toward precision medicine and multidisciplinary management as the foundation of contemporary advanced thyroid cancer care. Continued efforts to improve access to innovative technologies and specialized treatment resources will be necessary to optimize patient outcomes throughout the American continent.
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