Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer

Abstract

BACKGROUND:Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients.OBJECTIVE:The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy.METHODS:Sixty‐five patients, treated in two tertiary‐care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor‐Node‐ Metastasis; Age‐Metastasis‐Extracapsular‐Size; distant Metastasis‐Age‐Completeness of primary tumor resection‐local Invasion‐Size and American‐Thyroid‐Association classificationRESULTS:Patients ages ranged from 4 to 20 years (median 14). The mean follow‐up was 12,6 years. Lymph node metastasis was found in 61.5% and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease‐free status in follow‐up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy.CONCLUSIONS:Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer.

Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases

“…One of these studies found greater chances of remission in patients more than 15 years of age (26). In contrast, the other reported greater likelihood of remission in patients < 10 years of age (38). However, findings of neither study were statistically significant.…”

“…Neck dissection was performed in 49 (92%) patients. Of these, modified radical neck dissection was carried out in 38 (22%) patients. Papillary and follicular histology were present in 46 (88%) and six (12%) patients, respectively.…”

Bone mineral density and bone microarchitecture after long-term suppressive levothyroxine treatment of differentiated thyroid carcinoma in young adult patients

“…Differentiated thyroid carcinoma (DTC), both papillary and follicular, is rare in pediatric patients, with an incidence between 2.6 and 12.9 % [1]. Primary treatment comprises thyroidectomy followed by radioiodine ablation and supraphysiologic doses of levothyroxine (LT 4 ) with the purpose of suppressing serum TSH and therefore inhibiting the growth of residual neoplastic tissue and preventing progression of thyroid cancer and relapse.…”

Pediatric thyroid carcinoma: experience in pediatric hospital

“…However, the procedure may require repetition, usually 6-12 months after the first procedure 36 . Some variables seem to influence the success of thyroid remnant ablation, and the most important one seems to be the presence of lymph node metastases 37 .…”