Objectives: Differentiated thyroid cancer (DTC) has shown increasing incidence in children and young people <19 years (CYP), and CYP present with more extensive disease than in adults and are at risk of long-term morbidity. A paucity of randomised controlled trials in the field has led to a lack of consensus on how these children should best be managed. These Childrens Cancer and Leukaemia Group and British Society for Paediatric Endocrinology and Diabetes commissioned guidelines intend to provide management guidelines for all paediatricians and paediatric endocrine, oncological, surgical, genetic and radiological specialists caring for CYP with suspected or confirmed DTC, thereby improving long term outcomes.
Methods: Guidelines were developed according to the AGREE II framework. Clinical questions were formulated based on a PICO (Population, Intervention, Comparison, Outcome) format by a multidisciplinary Guideline Development Group to guide systematic searches via the Ovid MEDLINE (Jan 1990Nov 2016) and Cochrane Library (2016, Issue 12) TRIP and EMBASE electronic registries, identifying 250 separate research articles. Publications underwent a three-tier filtering process and 164 were reviewed using the GRADE approach. For areas where recommendations could not be made based on published literature, a two-stage international Delphi consensus process was conducted to inform guideline recommendations.
Results: Sixty-four clinical questions were identified, leading to 42 recommendations which were largely based on low to very low quality evidence. Twenty-three further recommendations achieved >70% agreement via the Delphi consensus process. Important highlights include: the recommendation that all CYP with DTC are managed in an age-appropriate tertiary centre linked to a paediatric oncology centre with care co-ordinated by a clinician with expertise in DTC in conjunction with endocrinology, surgery and oncology; the recommendation to proceed to diagnostic surgery in cases of inconclusive cytology results; the recommendation that total thyroidectomy is indicated for initial surgical management, apart from in selected low risk cases; recommendations on risk stratification based on modified BTA guidelines; recommendations to perform therapeutic central neck lymph node dissection if pre-operative evidence or intra-operative biopsy evidence of loco-regional metastases exists; recommendations on the use, timing and administered activity of radioiodine remnant ablation and therapy; and recommendations for long-term biochemical and radiological follow-up.
Conclusions: These RCPCH collaborative guidelines provide the first UK evidence- and consensus-based national recommendations for the management of paediatric DTC. Through their implementation we hope to achieve better consistency in the investigation, management and ongoing follow up of CYP with DTC and improve long-term quality of survival.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology