Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in...

Area of Science:

• Endocrinology
• Pediatric Oncology
• Surgical Oncology

Background:

• Differentiated thyroid cancer (DTC) in children and adolescents presents unique challenges for treatment and long-term management.
• Locoregional recurrence (LR) remains a significant concern despite curative primary treatments.

Purpose of the Study:

• To evaluate the impact of extensive surgical treatment and postsurgical radioiodine therapy on reducing the risk of locoregional recurrence in pediatric DTC patients.
• To identify predictive factors for thyroid bed recurrence (TBR) and lymph node recurrence (NR).

Main Methods:

• Retrospective chart review and multivariate Cox regression analysis of 235 pediatric DTC patients (age ≤18 years) treated with curative intent.
• Analysis included assessment of surgical extent, radioiodine therapy, and recurrence patterns (TBR, NR).
• Kaplan-Meier and Cox univariate analyses were used to determine overall and recurrence-free survival.

Main Results:

• During a median follow-up of 82 months, 14% of patients experienced LR. Significant risk factors for TBR included less than total thyroidectomy and lack of postsurgical radioiodine.
• For NR, classic papillary histology, incomplete lymph node management, and absence of adjuvant radioiodine therapy were independent predictors of increased recurrence risk.
• No DTC-related deaths occurred, and 86% of patients remained recurrence-free.

Conclusions:

• Extensive initial therapy, comprising total thyroidectomy, modified lymphadenectomy for nodal metastases, and subsequent radioiodine therapy, is associated with a substantial decrease in DTC locoregional recurrence risk in patients aged 18 years or younger.
• This multimodal approach is critical for optimizing outcomes and minimizing recurrence in pediatric DTC.
• Age and sex were not found to correlate with locoregional recurrence risk.