Recommendations for Thyroid Cancer Surveillance Among Survivors of Childhood Cancer: A Report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Clinical/Translational
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 290
Sarah C. Clement1, Leontien C. Kremer1, Frederic Verburg2, Jill H Simmons3, Melanie Goldfarb4, Robin P. Peeters5, Erik Karl Alexander6, E. Bardi7, E. Brignardello8, LS Constine9, Catherine Anne Dinauer10, V. M. Drozd11, F. Felicetti8, E. Frey12, A. Heinzel13, Marry M. van den Heuvel-Eibrink14, Stephen Albert Huang15, Thera P Links16, K. Lorenz17, Renee L. Mulder1, Sebastian J.C.M.M. Neggers18, Ejm Nieveen van Dijkum19, KC Oeffinger20, Rick R. van Rijn19, Scott A Rivkees21, Cecile M. Ronckers1, Arthur B Schneider22, R. Skinner23, Jonathan Daniel Wasserman24, T. Wynn25, M.M. Hudson26, P. Nathan27 and Hanneke Margo van Santen*28
1Emma Children’s Hospital/Academic Medical Center, Amsterdam, Netherlands, 2University Hospital Aachen, Germany, 3Vanderbilt University Medical Center, Nashville, TN, 4University of Southern California Keck School of Medicine, Los Angeles, CA, 5Erasmus Medical Center, Rotterdam, Netherlands, 6Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 7Semmelweis University, Hungary, 8Città della Salute e della Scienza di Torino, 9James P. Wilmot Cancer Institute, University of Rochester Medical Center, 10Yale Univ Schl of Med, Guilford, CT, 11Belarusian Medical Academy for Postgraduate Education, 12St. Anna Children’s Hospital, 13University Hospital Aachen, 14Erasmus MC, Rotterdam, Netherlands, 15Boston Children's, Boston, MA, 16University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 17Martin-Luther University of Halle-Wittenberg, 18Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands, 19Academic Medical Center, Amsterdam, Netherlands, 20Memorial Sloan Kettering Cancer Center, 21University of Florida, Shands Children's Hospital, Gainesville, FL, 22Univ of IL at Chicago, Chicago, IL, 23Great North Children’s Hospital, 24The Hospital for Sick Children, Toronto, ON, Canada, 25Shands Hospital at the University of Florida, 26St Jude Children's Research Hospital, 27The Hospital for Sick Children, 28Wilhelmina Children's Hospital, Utrecht, Netherlands
BACKGROUND

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.

METHODS

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.  

RESULTS

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).

CONCLUSION

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

*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting/pr-resources-for-endo