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

Dardas, Majd; Abboud, Miguel R.; Salti, Ibrahim; Sabri, Alain; Shoucair, Mahmoud; Saleh, Monzer; Azar, Sami T.; Rodríguez‐Galindo, Carlos; Muwakkit, Samar

doi:10.1080/08880010903091806

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…However, there was no correlation between lymph node metastases at presentation and risk of recurrence. This finding is consistent with 1 previous report (22) but not with others (28,30,32). Some authors have reported a lower or higher incidence of initial lymph node involvement, ranging from 40% to 80% (5,12,17,18,20,22,32,33).…”

Section: Discussionsupporting

confidence: 82%

“…These data correlate with previously reported recurrence rates of 19%-24% (10,15,16). However, wider ranges (11%-32%) have been reported (12,(17)(18)(19)(20)(21), as have ranges as high as 39%-46% (5,22,23).…”

Section: Discussionsupporting

confidence: 81%

“…In agreement with those data, excellent disease-specific survival (98%) during the follow-up period (1-30 y) was found in the present study. Other authors have reported no disease-related deaths (5,21,22,30). Recurrence-free survival rates of 70%-80% and 73% at 5 y (10,15,21,34,37) and 10 y (15), respectively, have been reported.…”

Section: Discussionmentioning

confidence: 81%

“…Because thyroid carcinoma spreads in an intraglandular manner and can show multifocality, thyroid remnants are at risk for local relapse. Some authors have suggested a radical surgical approach as the initial surgical treatment performed by highly experienced surgeons (5,22). Enomoto et al (16) suggested that RAI should be used only in patients with large lymph nodes and distant metastases at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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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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