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New national recommendations for the treatment of pediatric differentiated thyroid carcinoma in the Netherlands
C A Lebbink1,2, B L Dekker3, G Bocca4
1Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (WKZ)/University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Insights
New Dutch guidelines for pediatric differentiated thyroid cancer (DTC) were developed due to a lack of European recommendations. These guidelines offer a framework for a future harmonized European DTC approach.
Area of Science:
- Endocrinology
- Pediatric Oncology
- Medical Guidelines
Background:
- No current European recommendations exist for pediatric thyroid cancer management.
- Existing international guidelines lack concordance and differ based on regional regulations.
- There is a need for accessible national guidelines for pediatric differentiated thyroid carcinoma (DTC) in the Netherlands.
Purpose of the Study:
- To develop new, easily accessible national recommendations for pediatric DTC patients in the Netherlands.
- To serve as a foundational step towards a harmonized European Recommendation for pediatric DTC.
- To address the current discordance in international guidelines and varying medical regulations.
Main Methods:
- A multidisciplinary working group was assembled, including various pediatric and adult specialists and a patient representative.
- A systematic literature search identified existing pediatric DTC guidelines and reviews from 2000-2019, assessed using the AGREE instrument.
- The American Thyroid Association (ATA) pediatric guideline (2015) was used as a framework, with expert opinion and Dutch clinical practice informing specific recommendations.
Main Results:
- A 2020 Dutch recommendation for pediatric DTC was created, integrating the latest evidence and expert consensus.
- The recommendation was published as an online, interactive decision tree accessible at www.oncoguide.nl.
- The developed guidelines provide a practical tool for managing pediatric DTC.
Conclusions:
- Pediatric differentiated thyroid carcinoma necessitates a multidisciplinary treatment approach.
- The 2020 Dutch Pediatric DTC Recommendation can initiate the development of a collaborative European guideline.
- Standardized European recommendations are crucial for optimal pediatric DTC care.
Background:
Currently, there are no European recommendations for the management of pediatric thyroid cancer. Other current international guidelines are not completely concordant. In addition, medical regulations differ between, for instance, the US and Europe. We aimed to develop new, easily accessible national recommendations for differentiated thyroid carcinoma (DTC) patients <18 years of age in the Netherlands as a first step toward a harmonized European Recommendation.
Methods:
A multidisciplinary working group was formed including pediatric and adult endocrinologists, a pediatric radiologist, a pathologist, endocrine surgeons, pediatric surgeons, pediatric oncologists, nuclear medicine physicians, a clinical geneticist and a patient representative. A systematic literature search was conducted for all existing guidelines and review articles for pediatric DTC from 2000 until February 2019. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used for assessing quality of the articles. All were compared to determine dis- and concordances. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework to develop specific Dutch recommendations. Discussion points based upon expert opinion and current treatment management of DTC in children in the Netherlands were identified and elaborated.
Results:
Based on the most recent evidence combined with expert opinion, a 2020 Dutch recommendation for pediatric DTC was written and published as an online interactive decision tree (www.oncoguide.nl).
Conclusion:
Pediatric DTC requires a multidisciplinary approach. The 2020 Dutch Pediatric DTC Recommendation can be used as a starting point for the development of a collaborative European recommendation for treatment of pediatric DTC.
