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ForwardEthosCE - Live Course - Pediatric Thyroid Cancer
During this live event learners will receive insturction on pediatric differentiated thyroid cancer and diagnosing and treatement of thryoid cancer in patients.
Context
Pediatric differentiated thyroid cancer (DTC) patients frequently present with lymph node and/or distant (lung) metastases. Such patients warrant an aggressive treatment consisting of surgical removal of all surgically accessible local metastases as well as further treatment with one or more courses of radioiodine therapy (RAI). It is still a subject of debate in literature how much I-131 should be administered to pediatric patients. Patients can either be given a fixed (possibly body weight adjusted) activity or a dosimetry based activity, which is often considerably higher.
Objective
Here, we will present a typical case of a pediatric patient who was treated using a dosimetric approach. Then we will discuss the basis of dosimetry and the procedures involved, followed by a discussion of when to use dosimetric RAI as well as the pros and cons of the various approaches in pediatric patients.
Results
In general, two opposite approaches to dosimetry exist: either the activity that is as high as safely administrable (AHASA) is determined based on the radiation exposure to the critical organs at risk (in pediatric patients these are the bone marrow and, in patients with lung metastases, the lungs), or a lesion-based approach in which the activity that is required to deliver a certain radiation dose to the metastatic lesion(s) is determined.
Conclusion
Because the latter approach requires an accurate volumetry of the target lesion(s), which is not possible in children with disseminated pulmonary metastases, which are often not visible with morphologic imaging techniques, we advocate using the AHASA approach in children with extensive metastatic DTC.
Frederik A. Verburg, Christoph Reiners, and Heribert Hänscheid
DOI: http://dx.doi.org/10.1210/jc.2013-2259
Received: May 16, 2013
Accepted: July 19, 2013
Published Online: December 04, 2013
Target Audience
Endocrinologists/Pediatric Endocrinologists
Radiologists
Learning Objectives
Learners will be able to:
* Have an understanding of different approaches to dosimetry of radioiodine therapy
* Determine best approach for treating patient
| Time | Title |
|---|---|
| 7:30 AM | Registration and Continental Breakfast |
| 8:00 | Welcome and Introduction Frederik A. Verburg, M.D., Ph.D. Christoph Reiners, M.D. |
| Diagnosing Pediatric Thyroid Cancer | |
| MODERATOR: David Handelsman, Ph.D. | |
| 8:15 | Recognizing Signs of Thyroid Cancer in Children Frederik A. Verburg, M.D., Ph.D. |
| 8:30 | Diagnostic Tools for Detecting Thyroid Cancer in Children Lynnette Nieman, M.D. |
| 8:45 | Selecting the Right Treatment for Your Patient with Thyroid Cancer Christoph Reiners, M.D. |
| 9:00 | Recognizing Common Side Effects Pediatric Cancer Treatment Heribert Hänscheid, M.D. |
| 9:15 | What's on the Horizon for Treating Thyroid Cancer in Children? Leonard Wartofsky, M.D. |
| 9:30 | Preparing the Child and Family for Treatment Kenneth Burman, M.D. |
| 9:45 | Panel Discussion Drs.Frederik A. Verburg, Lynnette Nieman, and Leonard Wartofsky, M.D. |
| 10:00 | Coffee Break |
| Pediatric Thyroid Cancer | |
| MODERATOR: David Ehrmann, M.D. | |
| 10:15 | Psychological Affects in Children Suffering from Cancer |
| 10:30 | Life After Treatment Merrily Poth, M.D. |
| 10:45 | Controversies in Treatment Constantine Stratakis, M.D. |
| 11:00 | Coffee Break |
| 11:15 | Family Support for Children with Cancer Michael Kleerekoper, M.D. |
| 11:30 | Panel Discussion Drs. Michael Kleerekoper, Merrily Poth, Constantine Stratakis |
| 12:00 pm Lunch | |
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Authors, editors, and Endocrine Society staff involved in planning this live CME activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. The Endocrine Society has reviewed all disclosures and resolved all identified conflicts of interest.
The following authors reported relevant financial relationships:
Frederik A. Verburg, M.D., Ph.D., has received speakers' fees and research support from Genzyme Corp. and is a paid member of an advisory board for Roche Healthcare.
Christoph Reiners, M.D., has received speakers' fees and research support from Genzyme Corp.
The following author reported no relevant financial relationships:
Heribert Hänscheid, M.D., has no relevant financial relationships.
The following JCEM Editors reported relevant financial relationships:
The Editor-in-Chief, Leonard Wartofsky, M.D., is a Consultant for Asurogen, Genzyme, and IBSA, and is on the Speaker's Bureau for Genzyme.
Kenneth Burman, M.D., is a Consultant for Medscape and UpToDate; a Reviewer for the Endocrine Fellows Foundation; and has received Institutional Grants for Research from Amgen, Eisei, and Pfizer.
Lynnette Nieman, M.D., is an Author/Editor for UpToDate, and receives Research Support from HRA-Pharmaceutical.
The following JCEM Editors reported no relevant financial relationships:
Paolo Beck-Peccoz, M.D.; David Ehrmann, M.D.; David Handelsman, Ph.D.; Michael Kleerekoper, M.D.; Merrily Poth, M.D.; Constantine Stratakis, M.D.
Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.
Acknowledgement of Commercial Support
JCEM Journal-based CME activities are not supported by grants, other funds, or in-kind contributions from commercial supporters.
The (NAME OF YOUR ORGANIZATION) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American College of Obstetricians and Gynecologists has assigned up to 3 cognate credits to this program.
This activity is approved 3.0 contact hour(s) of continuing education (which includes 1 hours of pharmacology) by the American Association of Nurse Practitioners. Activity ID 123456789. This activity was planned in accordance with AANP CE Standards and Policies.
This Live activity, has been reviewed and is acceptable for up to 3.00 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This program has been accredited by the American Osteopathic Association for 3.0 credits of AOA Category 2-A.
Other Health Care Professionals
A record of attendance will be available to other health care professionals for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations.