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Childhood and adolescent thyroid carcinoma
Perry W Grigsby1, Anat Gal-or, Jeff M Michalski
1Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri 63110, USA. grigsbyp@netscape.net
Cancer
|September 5, 2002
Summary
Pediatric thyroid carcinoma has low mortality but high recurrence risk, especially in younger patients with advanced disease. Comprehensive treatment including surgery, radioactive iodine, and hormone therapy is crucial for managing this condition.
Area of Science:
- Pediatric Oncology
- Endocrinology
Background:
- Thyroid carcinoma in children and adolescents presents unique challenges compared to adult populations.
- Understanding factors influencing outcomes is critical for optimizing treatment strategies.
Purpose of the Study:
- To evaluate clinical and treatment factors affecting local tumor control, distant metastasis, survival, and complications in pediatric and adolescent thyroid carcinoma patients.
- To identify predictors of recurrence and inform management approaches.
Main Methods:
- Retrospective review of 56 pediatric and adolescent patients (4-20 years) with papillary and follicular thyroid carcinoma.
- Analysis included diagnostic stage, surgical procedures (total thyroidectomy, subtotal thyroidectomy, lobectomy), and adjuvant therapies (thyroid hormone suppressive therapy, radioactive iodine ((131)I)).
Main Results:
- Overall survival was high (98%), with the single death unrelated to cancer.
- The 10-year progression-free survival was 61%, and 34% of patients experienced recurrence.
- Recurrence was significantly associated with lymph node metastasis, lung metastasis, thyroid capsule invasion, soft tissue invasion, positive margins, and advanced tumor stage at diagnosis (P=0.02).
- Younger patients (<15 years) were more likely to present with advanced disease.
Conclusions:
- Pediatric and adolescent thyroid carcinoma carries a low mortality risk but a substantial risk of recurrence.
- Younger age at diagnosis is linked to more advanced disease and higher recurrence rates.
- Recommended management includes total thyroidectomy, lymph node dissection, postoperative (131)I therapy, thyroid hormone suppressive therapy, and close surveillance.