Long‐Term Outcome in 215 Children and Adolescents with Papillary Thyroid Cancer Treated During 1940 Through 2008

Hay, Ian; Gonzalez-Losada, Tomas; Reinalda, Megan S.; Honetschlager, Jennifer A.; Richards, Melanie L.; Thompson, Geoffrey B.

doi:10.1007/s00268-009-0364-0

Cited by 284 publications

(308 citation statements)

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“…However, importantly, despite having more advanced disease, children are less likely to ultimately die of the disease than adults [29,30]. Fortunately, even in the presence of metastatic disease, 30-yr survival rates are as high as 90-99% [25,31].Survival is favourable in children even in metastatic disease than adults, since pulmonary metastases can remain stable for extended periods [28,32].…”

Section: Clinical Features and Behaviourmentioning

confidence: 99%

“…Some surgeons cite the excellent survival in these patients counterbalancing the morbidity of aggressive surgery, and hence recommend conservative surgery [35,36] Most surgeons prefer to perform a total thyroidectomy for pediatric DTCs [6,7,22,25,29,[37][38][39][40], and the arguments in favour of this are multifold: (a) Multifocal disease occurs in 40% of pediatric PTC, and has a greater risk for recurrence; (b) Pediatric DTC commonly has regional lymph node disease and a greater risk for distant metastasis; (c) Total thyroidectomy will facilitate the future use of radioactive iodine (RAI) where indicated; (d) Postoperative RAI scans and thyroglobulin assays can be best used after total thyroidectomy, these are especially useful in picking pulmonary metastases that may be undetected on initial X-ray. We found that an initial X-ray of chest picked only about 31% of pulmonary metastases [3].…”

Section: Treatment -Surgerymentioning

confidence: 99%

“…Further support for total thyroidectomy in pediatric thyroid cancers comes from four large cohort studies, which have found that relapse rates are more with lobectomy than with total thyroidectomy [2,29,39,40] To keep the controversy alive, there is a school of thought from Waguespack and Francis, who consider lobectomy for 'low-risk patients with incidental micro-PTC or small (< 1 cm) unifocal tumors as long as pre-and postoperative staging fail to identify multifocal disease in the thyroid or cervical lymph node involvement' [7].…”

Section: Treatment -Surgerymentioning

confidence: 99%

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Pediatric Thyroid Cancers: An Indian Perspective

Chaukar

Vaidya

2012

Indian J Surg Oncol

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Pediatric thyroid cancer is a rare entity accounting for less than 5% of all thyroid cancers. This intriguing disease is characterized by advanced presentation, coupled with frequent lymph nodal metastases and often pulmonary metastases. It perhaps exhibits a distinct biology and behaviour, because in spite of its aggressiveness, survival is extremely good. This mandates meticulous treatment decisions that are well executed, because the complications of therapy in patients with good survival may spell prolonged morbidity. Being an unusual disease, it is unlikely that level I evidence guiding the management will come forth. There have been controversies regarding management, and the current consensus comes from large prospective studies. There have been only a few studies from India detailing pediatric thyroid cancers. In the current discussion, we review the existing evidence about pediatric thyroid cancers, and try to have an Indian perspective at the problem.

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Section: Clinical Features and Behaviourmentioning

confidence: 99%

Section: Treatment -Surgerymentioning

confidence: 99%

Section: Treatment -Surgerymentioning

confidence: 99%

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Pediatric Thyroid Cancers: An Indian Perspective

Chaukar

Vaidya

2012

Indian J Surg Oncol

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“…In a large retrospective study of pediatric patients with PTC who had extended follow-up, partial thyroidectomies carried larger rates of disease recurrence than bilateral thyroidectomies. 1 Further understanding of the genetics of pediatric PTC may help stratify patients and identify subgroups who could safely be treated with subtotal thyroidectomy. Tumor genetics of course can present opportunities for targeted therapy, which could be used as adjuvant therapy for individuals with very limited disease treated with subtotal thyroidectomy or in the rare, unfortunate patients with recalcitrant, advanced disease.…”

Section: Commentmentioning

confidence: 99%

“…2016;140:134-139; doi: 10.5858/ arpa.2014-0612-OA) P apillary thyroid carcinoma (PTC) is an uncommon tumor in the pediatric population. Despite having an excellent prognosis with long-term mortality rates of less than 1%, 1,2 pediatric patients with PTC tend to present with advanced disease often with increased rates of extrathyroidal tumor extension, lymphovascular invasion, and distant metastases. 1,[3][4][5] The distinct clinical nature of papillary thyroid cancer in the pediatric population has prompted interest in the molecular tumorigenesis.…”

mentioning

confidence: 99%

Mutation in BRAF and Other Members of the MAPK Pathway in Papillary Thyroid Carcinoma in the Pediatric Population

Gertz

Nikiforov

Rehrauer

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Papillary thyroid carcinoma (PTC) is an uncommon tumor in the pediatric population. A limited number of studies have examined genetic mutations affecting the mitogen-activated protein kinase (MAPK) pathway in the pediatric population.Objective.-To examine mutations affecting this pathway in PTC in our pediatric population and compare the BRAF V600E mutation rates in pediatric and adult tumors.Design.-Eighty-four patients, including 14 pediatric and 70 adult, with PTC were tested for the BRAF V600E mutation by using real-time polymerase chain reaction and sequencing. Additionally, we examined the rate of RAS point mutations with real-time polymerase chain reaction and rearrangements of RET/PTC1 and RET/PTC3 in the pediatric group with fluorescence in situ hybridization. Clinical and histologic data were compared as well.Results.-Of 77 tumors that had an interpretable result, the BRAF V600E mutant was identified in 4 of 13 pediatric patients (31%) and 43 of 64 adult patients (67%), which was a significant difference (using Fisher exact test, P ¼ .03). One pediatric and 6 adult cases did not reveal an interpretable result with melting curve analysis. One of these cases harbored a rare 3-base pair deletion mutation (c.1799_1801delTGA). Mutations in RAS genes were not seen in any pediatric tumors. One tumor with a RET/PTC1 rearrangement and another with RET/PTC3 were identified in the pediatric population (15%).Conclusions.-The rate of the BRAF V600E mutation in the pediatric population is significantly lower than that seen in the adult population. Mutations in RAS do not contribute significantly to pediatric PTC. This experience from our institution adds to the growing body of knowledge regarding tumor genetics in pediatric PTC.(Arch Pathol Lab Med. 2016;140:134-139; doi: 10.5858/ arpa.2014-0612-OA) P apillary thyroid carcinoma (PTC) is an uncommon tumor in the pediatric population. Despite having an excellent prognosis with long-term mortality rates of less than 1%, 1,2 pediatric patients with PTC tend to present with advanced disease often with increased rates of extrathyroidal tumor extension, lymphovascular invasion, and distant metastases. 1,3-5The distinct clinical nature of papillary thyroid cancer in the pediatric population has prompted interest in the molecular tumorigenesis. The mitogen-activated protein kinase (MAPK) pathway includes components of particular interest, including BRAF, RAS, and RET. Between 37% and 52% of PTCs have been linked to the specific BRAF mutation V600E, and clinical correlations support that this foretells a more aggressive disease course in adults. [6][7][8][9] The incidence of this BRAF mutation in the pediatric population is thought to be lower than in adults with rates of 0% to 37%, 10-15 though 1 recent series 16 revealed a rate of 63%. The rearrangement mutations of RET are also considered a major contributor to PTC tumorigenesis, but rates of this mutation have fluctuated widely in reported series.17 RET/PTC rearrangements have been associated with young age 18 an...

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Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients

Sudoko

Jenks

Bauer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThe current recommendation for pediatric patients with papillary thyroid cancer (PTC) is a total thyroidectomy. This recommendation applies to all stages of PTC, including papillary thyroid microcarcinoma (Յ1 cm, T1a) tumors. OBJECTIVE To evaluate the characteristics of American Joint Committee on Cancer T1 PTC tumors in a large pediatric population and to identify a subgroup of patients who may benefit from a thyroid lobectomy instead of a total thyroidectomy. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted from January 1, 2009, to May 31, 2020. The study took place at a tertiary care medical center and included 102 patients who were surgically treated for T1 PTC: 52 with stage T1a (Յ1 cm) tumors and 50 with stage T1b (>1 cm but Յ2 cm) tumors. MAIN OUTCOMES AND MEASURES Primary outcomes included the presence of bilateral disease and lymph node metastasis.RESULTS A total of 102 patients (mean age, 15.3 years [range, 9.7-18.9 years]; 84 girls [82.4%]) were included in the analysis. Among 52 patients with T1a tumors, 10 (19.2%) had bilateral disease, and 15 (28.8%) had central neck lymph node (N1a) metastasis. Among 50 patients with T1b tumors, 10 (20%) had bilateral and 13 (26%) had N1a disease. Of those with T1a, unilateral multifocality was associated with bilateral disease (odds ratio [OR], 2.1; 95% CI, 1.3-3.4) and N1a disease (OR, 5.1; 95% CI, 1.5-17.6). Both N1a disease (OR, 20.0; 95% CI, 3.5-115.0) and Ն4 positive lymph nodes (OR, 8.6; 95% CI, 1.2-60.9) were associated with bilateral disease. In patients with no pathologic evidence of lymph node metastasis (N0), there was a 95% rate of unilateral PTC. In patients with T1b tumors, unilateral multifocality was also associated with bilateral disease (OR, 1.8; 95% CI, 1.3-2.7). Patients with T1b tumors had an increased risk of lateral (N1b) neck lymph node metastasis when compared with those with T1a tumors (OR, 3.7; 95% CI, 1.0-14.5). CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that, in patients with unifocal T1a PTC without clinically evident nodal disease on preoperative ultrasonography, a thyroid lobectomy and central neck dissection may be considered. If there is no evidence of unilateral multifocality or if there are fewer than 4 positive lymph nodes on postoperative pathology, then close observation may be considered. These findings have substantial clinical implications and may result in practice changes regarding the extent of thyroid surgery on low-stage pediatric PTC.

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Long‐Term Outcome in 215 Children and Adolescents with Papillary Thyroid Cancer Treated During 1940 Through 2008

Abstract: Survival from childhood PTC should be expected, but later death from nonthyroid malignancy is disconcerting. Seventy-three percent of those who died from nonthyroid malignancy had received postoperative therapeutic irradiation.

Cited by 284 publications

References 70 publications

Pediatric Thyroid Cancers: An Indian Perspective

Pediatric Thyroid Cancers: An Indian Perspective

Mutation in BRAF and Other Members of the MAPK Pathway in Papillary Thyroid Carcinoma in the Pediatric Population

Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients

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