Surgical therapy of the thyroid papillary carcinoma in children: Experience with 56 patients ≤16 years old

Spinelli, Claudio; Bertocchini, Alessia; Antonelli, Alessandro; Miccoli, Paolo

doi:10.1016/j.jpedsurg.2004.06.016

Cited by 82 publications

(65 citation statements)

References 31 publications

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“…Patients who underwent TTx and RAI had a lower probability of recurrence than those who initially underwent less intense therapy (STTx) (P 5 0.0001). Although there is some controversy about the influence of the extent of initial treatment on recurrence in juvenile DTC (9,19,20,29), our results confirmed that TTx followed by RAI reduced the risk of relapse; 67.4% of patients who initially underwent TTx followed by RAI (group 1) achieved complete remission, 30.4% achieved partial remission, and 2.2% had progressive disease. During the follow-up period, recurrence developed in 11 of 51 patients (21.6%) (6/11 patients in group 1 and 5/11 patients in groups 2 and 3).…”

Section: Discussionsupporting

confidence: 76%

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Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

2014

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The overall prognosis in pediatric differentiated thyroid carcinoma (DTC) is excellent. Recurrent disease is frequent, however, and requires additional treatment. We analyzed the probability of recurrence, prognostic factors, treatment, and outcome of juvenile DTC. Methods: Fifty-one DTC patients (32 girls and 19 boys; ≤20 y old; mean age, 16.5 y) were treated with 131 I (radioiodine, or radioactive iodine [RAI]); the median follow-up was 10 y. Patients underwent different initial treatments: 46 patients received total thyroidectomy and RAI, 3 patients received total thyroidectomy, and 3 patients received subtotal thyroidectomy. The probability of recurrence and prognostic factors were tested with the Kaplan-Meier method. Results: Initially, 36 of 51 patients achieved complete remission, 14 of 51 achieved partial remission, and 1 of 51 had progressive disease. By the follow-up, 11 of 51 patients (21.6%) had developed recurrent disease; the median appearance time was 4 y (range, 1-15 y). The probabilities of recurrence were 16.7% at 5 y, 22.3% at 10 y, and 33.3% at 15 and 23 y after the initial treatments. Factors that were strongly predictive of recurrence were age (P 5 0.001), initial treatment (P 5 0.0001), and tumor multifocality (P 5 0.011). Sex, nodal metastases at presentation, distal metastases at presentation, histologic type of the tumor, T stage, and clinical stage had no influence on relapse (P 5 0.180, P 5 0.786, P 5 0.796, P 5 0.944, P 5 0.352, and P 5 0.729, respectively). Patients with recurrent disease, partial remission, and progressive disease were retreated, with either surgery or surgery and RAI, receiving cumulative activities of up to 40 GBq. The overall outcome in our patients was excellent: 90.2% complete remission, 3.92% partial remission, 1.96% stable disease, 1.96% disease-related death, and 1.96% another cause of death. Conclusion: Younger age at diagnosis, less radical primary surgery without subsequent RAI, and tumor multifocality are factors that are strongly prognostic for recurrence. For reducing the rate of relapse and improving surveillance for recurrent disease, total thyroidectomy followed by RAI appears to be the most beneficial initial treatment for patients with juvenile DTC. The use of RAI seems to be safe, with no adverse effects on subsequent fertility and pregnancy or secondary malignancy.

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Section: Discussionsupporting

confidence: 76%

“…Recurrent disease is frequent in multicentric PTC (11,29,31). Some authors have found that tumor multifocality increases the risk of regional recurrence, metastases, and poor outcomes (31).…”

Section: Discussionmentioning

confidence: 99%

Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

2014

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“…It was found that Belarusian cases developed during the first decade after exposure had the greater aggressiveness at presentation and were diagnosed at the younger age. Spinelli et al (35) compared radiogenic and sporadic childhood cases of papillary thyroid carcinomas to demonstrate the frequency of recurrences of 64% and 3% in patients exposed and not exposed to radiation, respectively. In this work, the higher prevalence of distant metastases and recurrent local relapses were recognized to be particularly associated with the radiogenic thyroid malignancies.…”

Section: Clinical Course Of Childhood Patients With Thyroid Cancermentioning

confidence: 99%

Childhood thyroid cancer in Belarus, Russia, and Ukraine after Chernobyl and at present

Demidchik

Saenko

Yamashita

2007

Arq Bras Endocrinol Metab

121

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Thyroid cancer in children is usually rare, but in the individuals exposed to radiation risk of disease increases considerably. After the Chernobyl accident in 1986, an over 10-fold maximal elevation in the incidence of thyroid cancer was registered about a decade later, cumulatively resulting in more than a thousand of newly diagnosed cases in children who lived in the territories of Belarus, Russia, and Ukraine affected by radioactive fallouts. Experience from the epidemic substantially promoted knowledge in clinical pediatric oncology, pathology and basic sciences. This article overviews epidemiology, clinical features, results of treatment and followup of childhood patients with radiation-induced Chernobyl thyroid cancer in comparison to sporadic cases diagnosed at present. In addition, we discuss general issues of pathology and molecular findings in childhood thyroid carcinomas. RESUMOCâncer de Tiróide na Infância na Bielorússia, Rússia, e na Ucrânia, Após Chernobil e Atualmente. O câncer de tiróide é habitualmente raro em crianças, mas em indivíduos expostos a radiação o risco da doença aumenta consideravelmente. Cerca de uma década após o acidente de Chernobil, em 1986, foi registrado um aumento de mais de 10 vezes na incidência de câncer de tiróide, resultando cumulativamente em mais de mil novos casos diagnosticados em crianças que viviam nos territórios da Bielorrússia, Russia, e Ucrânia, afetadas pela chuva radioativa. A experiência com essa epidemia resultou em conhecimento substancial de oncologia pediátrica clínica, patologia e ciências básicas. Este artigo analisa a epidemiologia, os achados clínicos, os resultados do tratamento e a evolução de pacientes pediátricos com câncer de tiróide induzido pela radiação de Chernobil, em comparação com casos esporádicos diagnosticados atualmente. Adicionalmente, serão discutidos tópicos de patologia e achados moleculares no carcinoma de tiróide infantil.

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“…Several major papers of the late 1980's summarizing the largest centers' earlier experience also are included (Schlumberger et al 1987, La Quaglia et al 1988, Zimmerman et al 1988. Because it currently is likeliest to be seen in most clinical practices, sporadic pediatric DTC is emphasized and studies with >25% of patients with radiation-induced DTC (Tronko et al 1999, Gow et al 2003, Spinelli et al 2004) have, with one exception (Harness et al 1992) been excluded, as have those devoted only to distant metastatic cases (Vassilopoulou-Sellin et al 1995, Brink et al 2000, Reiners et al 2002.…”

Section: Primary Treatment Strategiesmentioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

169

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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Surgical therapy of the thyroid papillary carcinoma in children: Experience with 56 patients ≤16 years old

Cited by 82 publications

References 31 publications

Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

Childhood thyroid cancer in Belarus, Russia, and Ukraine after Chernobyl and at present

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

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