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Outcomes of ATA Low-Risk Pediatric Thyroid Cancer Patients Not Treated With Radioactive Iodine Therapy
Mya Bojarsky1, Julia A Baran1, Stephen Halada1
1Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Withholding radioactive iodine therapy (RAIT) for pediatric differentiated thyroid cancer (DTC) patients classified as low-risk by the American Thyroid Association (ATA) does not lower remission rates. This approach avoids radiation exposure and maintains similar outcomes to RAIT.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Nuclear Medicine
Background:
- The American Thyroid Association (ATA) guidelines suggest withholding radioactive iodine therapy (RAIT) for differentiated thyroid cancer (DTC) cases confined to the thyroid.
- Ongoing concerns exist regarding potential impacts on remission rates when RAIT is withheld for pediatric DTC patients.
Purpose of the Study:
- To investigate whether withholding RAIT in ATA low-risk pediatric DTC patients affects remission rates compared to those receiving RAIT.
- To evaluate factors influencing RAIT administration and remission outcomes in this cohort.
Main Methods:
- Retrospective review of medical records for patients under 19 diagnosed with DTC and treated with total thyroidectomy (2010-2020).
- Multivariate logistic regression analysis to identify predictors of RAIT use and remission.
- Comparison of 1-year and long-term remission rates between patients treated with and without RAIT.
Main Results:
- Ninety-five low-risk pediatric DTC patients were analyzed; 53% received RAIT, 47% did not.
- RAIT use decreased significantly after 2015 (82% before vs. 33% after, P < .01).
- No significant difference in 1-year remission rates was observed (70% with RAIT vs. 69% without RAIT). Long-term remission rates were also comparable (82% vs. 76%).
Conclusions:
- Withholding RAIT for pediatric low-risk DTC patients is safe and does not negatively impact remission rates.
- This approach effectively avoids unnecessary radiation exposure.
- Dynamic risk stratification at 1-year post-treatment is appropriate for assessing outcomes in patients not receiving RAIT.
Context:
The American Thyroid Association (ATA) Pediatric Guidelines recommend patients not receive radioactive iodine therapy (RAIT) for differentiated thyroid cancer (DTC) confined to the thyroid. Since publication, there is ongoing concern whether withholding RAIT will result in a lower rate of remission.
Objective:
This study explores whether ATA low-risk patients treated with and without RAIT achieved similar remission rates.
Methods:
Medical records of patients <19 years old diagnosed with DTC and treated with total thyroidectomy between 2010 and 2020 were reviewed. Multivariate logistic regression was performed to evaluate factors influencing RAIT administration and remission rate.
Results:
Ninety-five patients with ATA low-risk DTC were analyzed: 53% (50/95) and 47% (45/95) were treated with and without RAIT, respectively. RAIT was used to treat 82% of patients before 2015 compared with 33% of patients after 2015 (P < .01). No significant difference in 1-year remission rate was found between patients treated with and without RAIT, 70% (35/50) vs 69% (31/45), respectively. With longer surveillance, remission rates increased to 82% and 76% for patients treated with and without RAIT, respectively. Median follow-up was 5.8 years (IQR 4.3-7.9, range 0.9-10.9) and 3.6 years (IQR 2.7-6.6; range 0.9-9.3) for both cohorts. No risk factors for persistent or indeterminate disease status were found, including RAIT administration, N1a disease, and surgery after 2015.
Conclusion:
Withholding RAIT for pediatric patients with ATA low-risk DTC avoids exposure to radiation and does not have a negative impact on remission rates. Dynamic risk stratification at 1-year after initial treatment is a suitable time point to assess the impact of withholding RAIT for these patients.
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