Session: SAT 270-310-Thyroid Neoplasia (posters)
Poster Board SAT 290
Survivors of childhood cancer who received radiotherapy exposing the thyroid gland are at increased risk of developing differentiated thyroid cancer (DTC). Clinical practice guidelines are essential to ensure that these individuals receive optimum and consistent surveillance and to avoid overdiagnosis/overtreatment. We aimed to develop evidence-based recommendations for childhood cancer survivors (CCS) at risk for developing DTC.
The development of this guideline was commissioned by the International Guideline Harmonization Group (IGHG). The IGHG assembled an international multidisciplinary expert panel. The topics addressed by four different working groups were: 1) Who do we need to screen? 2) What surveillance modality should be used? 3) At what frequency and for how long should thyroid cancer surveillance be performed? and 4) What should be done when abnormalities are identified? Relevant literature was identified using systematic PubMed searches and supplemented with additional articles identified from reference lists of all eligible studies. The task force members examined and synthesized relevant literature to develop a series of specific recommendations. The quality of the evidence and the strength of the recommendations were measured according to a set of criteria that were based on modified GRADE and the ACC/AHA classification for recommendations.
CCS treated with therapeutic 131I-MIBG or radiotherapy to a field that directly or incidentally exposes the thyroid gland are at increased risk for developing DTC. There is currently no evidence that treatment with chemotherapy alone is associated with elevated risk. Evidence supports the benefit of detecting DTC at an early stage. Therefore, surveillance for DTC is reasonable for CCS at high risk. However, available evidence is insufficient to formulate a recommendation regarding the preferred surveillance modality to detect a thyroid nodule, (neck palpation vs. thyroid ultrasonography), since both modalities have advantages and disadvantages. The choice of surveillance modality should be made by the health care provider in consultation with the survivor, based on the provider’s experience and the survivor’s preferences. It is reasonable to commence surveillance 5 years after radiation or therapeutic 131I-MIBG exposure. Referral to a thyroid specialist is recommended for survivors with a thyroid nodule (either palpable or found on thyroid ultrasonography).
We have developed evidence-based recommendations to aid in decision making for the detection of thyroid nodules and DTC in CCS and to highlight what we believe to be rational and optimal care based on current knowledge. These recommendations will facilitate more transparent decisions that reflect a balanced consideration of relevant factors, enabling individualized risk-based follow-up care for CCS worldwide.
Nothing to Disclose: SCC, LCK, FV, JHS, MG, RPP, EKA, EB, EB, LC, CAD, VMD, FF, EF, AH, MMV, SAH, TPL, KL, RLM, SJCMMN, EN, KO, RRV, SAR, CMR, ABS, RS, JDW, TW, MMH, PN, HMV
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