Pediatric papillary thyroid cancer: current management challenges

Abstract

Although with a standardized incidence of 0.54 cases per 100,000 persons, differentiated thyroid cancer (DTC) is a rare disease in children and adolescents, it nonetheless concerns ~1.4% of all pediatric malignancies. Furthermore, its incidence is rising. Due to the rarity and long survival of pediatric DTC patients, in most areas of treatment little evidence exists. Treatment of pediatric DTC is therefore littered with controversies, many questions therefore remain open regarding the optimal management of pediatric papillary thyroid cancer (PTC), and many challenges remain unsolved. In the present review, we aim to provide an overview of these challenging areas of patient and disease management in pediatric PTC patients. Data on diagnosis, surgery, radionuclide, and endocrine therapy are discussed, and the controversies therein are highlighted.

Differentiated thyroid cancer in children: Heterogeneity of predictive risk factors

“…The recurrence rate in these patients is in the range of 1-3%, and nearly all recurrences occur within the first 5 years after diagnosis. 36 Our study confirms that although paediatric DTCs present characteristics of aggressive disease at diagnosis more often than adult DTCs, their response to treatment is better and their outcome is more favourable than in adults. Predictive factors of outcome are heterogeneously indicated in different series, and only the presence of extensive regional metastases (in particular when the latero-cervical compartment is involved) may be considered a strong prognostic predictor of persistent/recurrent disease.…”

“…These results indicate that children with DTC that are free of detectable disease at early post‐treatment controls (negative Tg, neck ultrasound and 131 I WBS) most likely are truly disease‐free. The recurrence rate in these patients is in the range of 1–3%, and nearly all recurrences occur within the first 5 years after diagnosis …”

Papillary thyroid cancer in three children

“…Thyroid cancers (TC) are rare diseases in the paediatric population and represent 0.5-3% of all malignant tumours in children [1,2]. Differentiated thyroid cancer (DTC) is a major TC in children [3].…”

Pediatric papillary thyroid carcinoma successfully managed with a multimodal approach

“…Alternatively, a dosimetric strategy can be employed wherein the patient's individual iodine bio-kinetics is determined to calculate the 131 I activity which needs to be administered for therapy. 3 Some clinicians advocate 'fractionated' RIA therapy similar to fractionated radiotherapy. Such form of therapy alters PTC biokinetics and leads to selection of relatively radioresistant malignant cells, thereby, leading to decreased therapeutic efficacy of 131 I.…”

“…However, there exists limited evidence in literature regarding the activities of 131 I needed for radioablation in children. 3 Herein, we report a case of an 11-year-old-boy with PTC treated successfully with a multimodal approach consisting of total thyroidectomy and RIA.…”