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Thyroid cancer in children: the Royal Marsden Hospital experience
1Department of Clinical Oncology, Royal Marsden Hospital, London, UK. david.landau@rmh.nthames.nhs.uk
Insights
Thyroid stimulating hormone (TSH) suppression significantly reduces recurrence risk in pediatric well-differentiated thyroid cancer. Lifelong monitoring is crucial for these young patients.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Cancer Research
Background:
- Well-differentiated thyroid cancer (WDTC) in children is rare but requires long-term management.
- Treatment strategies have evolved significantly since 1917.
- Understanding long-term outcomes is critical for optimizing pediatric WDTC care.
Purpose of the Study:
- To review the management and outcomes of pediatric WDTC patients treated at a major cancer center.
- To identify prognostic factors for recurrence and survival.
- To evaluate the effectiveness of various treatment interventions.
Main Methods:
- Retrospective review of 30 children under 16 with WDTC treated from 1917 onwards.
- Analysis of patient demographics, treatment modalities, recurrence patterns, and survival data.
- Statistical analysis including hazard ratios (HR) and confidence intervals (CI) to assess risk factors and intervention effectiveness.
Main Results:
- Median follow-up was 22.5 years, with events occurring up to 44 years post-presentation.
- Younger age (≤10 years) and presence of metastases at diagnosis were associated with higher recurrence and poorer survival, respectively.
- Thyroid stimulating hormone (TSH) suppression was the only intervention significantly reducing recurrence risk (HR 11, P=0.0003).
- Recurrence significantly increased the risk of death and reduced survival.
Conclusions:
- Total or near-total thyroidectomy and radioiodine ablation (with exceptions) are recommended.
- Modified neck dissection for positive nodes and TSH suppression for all patients are advised.
- Lifelong follow-up with thyroglobulin measurements is essential for managing pediatric well-differentiated thyroid cancer.
Abstract:
The first child with well-differentiated thyroid cancer treated at the Royal Marsden Hospital presented in 1917. Since that time 30 children under the age of 16 years have been treated over a period during which many new treatments have been introduced. We have reviewed their management and outcome. The median follow-up is 22.5 years (range: 1-66). The median time to recurrence was 7 years (range: 2-44). There were events up to 44 years after presentation. The risk of recurrence was higher in children aged 10 years or younger [HR 3.45, 95% CI (1.04-11.11) P = 0.03]. Thyroid stimulating hormone (TSH) suppression was the only intervention to be shown to reduce the recurrence rate [HR 11, 95% CI (2.27-50) P = 0.0003]. The median overall survival is 53 years. The only presenting feature predictive of poorer survival was the presence of metastases (HR 28.96, 95% CI 2.51-334, P < 0.001). Patients who developed recurrence had a higher risk of death (HR 9.90, 95% CI 0.98-100, P = 0.02) and a shorter median survival of 30 years. No therapeutic intervention could be shown statistically to impact on survival. Our recommendation for treatment is total or near-total thyroidectomy for all patients and radioiodine ablation for all except those with early T stage node-negative disease aged over 10 years. Modified neck dissection is recommended for children with clinically positive neck nodes and TSH suppression for all. Follow-up with serial thyroglobulin measurement should be lifelong.