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

Abstract

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.

Recurrent Disease in Juvenile Differentiated Thyroid Carcinoma: Prognostic Factors, Treatments, and Outcomes

“…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).…”

“…The difference in the probabilities of recurrence between patients in group 1 and patients in group 3 was highly significant (P 5 0.001). Nevertheless, some authors have reported that age is not a significant risk factor for recurrent disease (19,28).…”

Therapeutic strategy for low-risk thyroid cancer in Kanaji Thyroid Hospital [Review]

“…Several studies from Western countries have demonstrated that total thyroidectomy offers a better prognosis than hemithyroidectomy [9][10][11][12][13][14][15][16][17]. These results might be low grade evidence, because there were not including randomized studies in almost of these reports.…”

Thyroid Cancer in the Pediatric Population

“…Total thyroidectomy remains the preferred operation in tumors greater than T1a (>1cm). It is generally accompanied by dissection of the central lymphatic compartment since local lymph node disease increases www.intechopen.com the risk of local and regional recurrence (Parisi, 2007, Niedziela, 2006, Handkiewicz, 2007. Patients who undergo total thyroidectomy have a higher rate of recurrence-free survival.…”

“…Nodal recurrences are more frequent in patients with the histologic subtype of papillary carcinoma, classical variant as compared to the follicular variant. Specifically, the 10 year nodal recurrence free survival has been reported at 83% for papillary carcinoma, classic type vs. 95% for the follicular variant type (Parisi, 2006, Luster, 2007, Handkiewicz, 2007.…”