Conservative surgical approach for thyroid and lymph‐node involvement in papillary thyroid carcinoma of childhood and adolescence

Abstract

Childhood and adolescence PTCs show a high rate of spread but an excellent outcome independent of the type of therapy (radical vs. conservative). Taking into account the marked responsiveness to TSH-suppression and the complications after radical therapy, in selected cases, a conservative approach should be considered, reserving more aggressive therapies in case of metastases or relapse.

THYROID CANCER IN LEBANESE CHILDREN AND ADOLESCENTS: A 15-Year Experience at a Single Institution

“…Advocates of the conservative approach report a lower incidence of surgery-related complications [13]. Also PTC is highly responsive to exogenous thyroid hormone, and l-thyroxine at TSH suppressive doses halts the glandular function of normal and malignant tissue [13].…”

“…Despite its high rate of invasiveness beyond the thyroid capsule, regional as well as distant metastasis, and local recurrences [4], pediatric thyroid carcinoma has excellent reported overall survival rates of more than 90% in most series 15-20 years postdiagnosis [1,2,8,13]. Adults > 40 years of age have significantly higher mortality from PTC than children [14].…”

Seminars: Controversies in the management of pediatric thyroid malignancy

“…This again, was a retrospective review of papillary thyroid cancer in children of Italy [11]. They reported that the overall progression-free survival, again, to be independent of type of surgery performed (total with lymph node dissection and I 131 ablation vs. lobectomy, selective lymph node dissection and thyroid suppression).…”

When adult cancers occur in children

“…What is more important, however, in the case of pediatric thyroid cancer, is the impact of these particular features on treatment. Given the excellent prognosis, combined with the high sensitivity of these cancers to suppressive hormone therapy, conservative surgery (i.e., hemithyroidectomy plus selective neck dissection only when nodes are clinically involved) may be warranted in many cases, inducing no negative effect on survival while minimizing postoperative complications and sequelae [9]. The problem is that many children with thyroid carcinoma currently receive…”

“…Another example is papillary thyroid carcinoma, which in childhood -unlike the adult disease -is characterized by an excellent overall survival (nearing 100%), irrespective of the clinical findings and despite its strong tendency for locoregional and distant spread [9]. This peculiar clinical behavior may have its corresponding biological feature in the RET/PCR3 translocation identified in the pediatric papillary subtype, while adult tumors (and the tall-cell variant in particular) are characterized by the BRAF mutation, which would coincide with an unfavorable outcome [10,11].…”