Pediatric Thyroid Cancers: An Indian Perspective

Abstract

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.

Differentiated thyroid carcinoma in children: A retrospective analysis of 125 pediatric cases from a single institution in India

“…Out of the 12 recurrences, nodal recurrence was the most common presentation as reported in the literature 8. The 5-year survival analysis of our patient cohort is comparable to other published literature 8,16. Azhar et al andLee et al…”

“…This dose was found to be effective and our patient cohort tolerated these doses very well. A review by Chaukar and Vaidya from India and Hung and Sarlis from the United States recommended 50–100 mCi for remnant and neck residual disease 16,25 . Our policy was a very similar strategy.…”

“…3,8 Distant metastasis present in 5.6% of children in our series, while Bal et al from All India Institute of Medical Sciences and Chaukar and Vaidya from Tata, Mumbai reported a higher rate of distant metastasis of 29% and 19%, respectively. 11,16 The higher health awareness in the state of Kerala due to its high literacy rate and the strong health care infrastructure that leads to early referral might have contributed to the predominant early presentation (Stage I disease)…”

“…A review by Chaukar and Vaidya from India and Hung and Sarlis from the United States recommended 50-100 mCi for remnant and neck residual disease. 16,25 Our policy was a very similar strategy. The American Thyroid Association (ATA) also recommends 30-100 mCi activity for achieving successful remnant ablation.…”

Pediatric Differentiated Thyroid Carcinoma Risk Factor For Analysis For Disease Free Survival

“…However, it remains unclear whether the pathology diagnosis and long-term outcomes differ between children and adolescent thyroid cancer patients. [3] Furthermore, despite their advanced pathological presentations, pediatric patients have better prognosis and significantly lower mortality rates than adult ones. This finding reveals that, even in similarly advanced stage at the time of diagnosis, long-term outcome and prognosis may differ between pediatrics and adult patients.…”