Surgical Experience in Children With Differentiated Thyroid Carcinoma

Haveman, Jan Willem; Tol, Karin M. van; Rouwé, Catrienus W.; Piers, D. A.; Plukker, John

doi:10.1245/aso.2003.03.002

Cited by 60 publications

(39 citation statements)

References 20 publications

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“…Twenty four children and 38 adolescents were treated over the 33-year period in a single institution with a mean follow-up of 112 months. The overall female to male ratio was 3.4:1 which is similar to other published studies [11,13,14]. All our patients are alive.…”

Section: Discussionsupporting

confidence: 90%

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Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

et al. 2014

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Section: Discussionsupporting

confidence: 90%

“…There are no published randomized prospective therapeutic trials yet [11,14,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Surgery of thyroid carcinoma in children varies among institutions regarding the surgery on thyroid gland and the lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

et al. 2014

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“…The present study did not include an extensive evaluation of surgical complications, as we are examining this issue in a separate study, based on formal decision analysis, which is similar to that of Kebebew et al in adult DTC patients (37). Rates of 0%-21% for hypoparathyroidism and 0%-17% for laryngeal nerve palsy are reported in the literature (8). With regard to radioiodine therapy sequelae, we observed a high rate of early minor, transient complications (nausea, vomiting).…”

Section: Discussionmentioning

confidence: 95%

“…The disagreement relates to both the indication for total thyroidectomy and the extent of cervical lymph node dissection. Some investigators recommend routine near-total or total thyroidectomy (2,(4)(5)(6)(7)(8), arguing that such surgery removes all malignant thyroid tissue, improves patient outcome, and makes follow-up more reliable. Other investigators advocate less aggressive treatment to decrease the risk of surgical complications (9)(10)(11).…”

mentioning

confidence: 99%

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

Handkiewicz-Junak

Włoch²,

Roskosz³

et al. 2007

Journal of Nuclear Medicine

184

139

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We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age #18 y. Methods: To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at age #18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan-Meier and Cox univariate analysis. Results: During a median follow-up of 82 mo (range, 5-402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was ,1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9-280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P 5 0.04] and 11 times [P 5 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P 5 0.02), 3.3 (P 5 0.02), and 3.2 (P 5 0.02) times, respectively. Age or sex did not correlate with LR risk. Conclusion: In DTC patients #18 y of age, extensive initial therapy-consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy-is associated with a substantial decrease of DTC LR risk.

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“…A common dilemma over the indication for radioiodine treatment arises when serum Tg levels are elevated, but the patient remains asymptomatic and all available imaging procedures have failed to localize the putative disease foci (Schlumberger et al 1997, van Tol et al 2003. This situation occurs in 10-15% of DTC patients, children included, and with respect to adults, has occasioned very intense controversy (McDougall 1997, Fatourechi et al 2002, Britton et al 2003.…”

Section: Radioiodine Treatment Of Metastatic Dtcmentioning

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

171

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 Experience in Children With Differentiated Thyroid Carcinoma

Cited by 60 publications

References 20 publications

Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

Surgical management of well-differentiated thyroid carcinoma in children and adolescents: 33 years of experience of a single institution in Serbia

Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer

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

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