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Multicenter Retrospective Analysis of Pediatric Differentiated Thyroid Carcinoma: Treatment Practices and Outcomes
Priya Mahajan1, Sarah Beth May2, Meghan Shekar3
1Division of Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.
Insights
Pediatric differentiated thyroid carcinoma (DTC) treatment before 2015 guidelines involved extensive surgery and radioactive iodine (RAI). Current guidelines may allow selective RAI use for low-risk cases, improving outcomes for pediatric thyroid cancer.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Nuclear Medicine
Background:
- Differentiated thyroid carcinoma (DTC) is the most common pediatric thyroid cancer, predominantly papillary thyroid carcinoma (PTC).
- The American Thyroid Association (ATA) established management guidelines for pediatric DTC in 2015.
Purpose of the Study:
- To evaluate pediatric DTC treatment practices at major children's hospitals before the 2015 ATA guidelines.
- To analyze treatment patterns in relation to patient demographics, diagnostic findings, and outcomes.
Main Methods:
- Retrospective analysis of 216 pediatric patients (<21 years) diagnosed with DTC between 2000-2015.
- Data collected from five major children's hospitals, including diagnostic evaluations, surgical procedures, and radioactive iodine (RAI) administration.
- Evaluation of treatment outcomes, including disease-free survival and overall survival, based on ATA risk stratification.
Main Results:
- Most patients were female (76%) with a median age of 14.8 years; common symptoms included neck swelling and nodules.
- Total thyroidectomy (78.7%) and lymph node dissection (75.5%) were common surgical procedures.
- Upfront RAI was administered to 83% of patients, with 1-year disease-free rates varying by risk: 66% (low), 59% (intermediate), and 13% (high). 5-year progression-free survival rates were 86% (low), 53% (intermediate), and 43% (high). Disease-related overall survival was 100%.
Conclusions:
- Pre-2015 pediatric DTC management typically involved aggressive surgical intervention and upfront RAI therapy.
- The findings suggest that selective RAI use for low-risk pediatric DTC, aligning with current ATA guidelines, may be a more appropriate approach.
Background:
Differentiated thyroid carcinoma (DTC) is the most common pediatric thyroid malignancy, with papillary thyroid carcinoma (PTC) representing 90% of the cases. In 2015, the American Thyroid Association (ATA) developed management guidelines for pediatric DTC.
Procedure:
Patients less than 21 years of age diagnosed with DTC between 2000 and 2015 at Texas Children's Hospital, Seattle Children's Hospital, Children's Healthcare of Atlanta, Children's Hospital Colorado, and Nationwide Children's Hospital were retrospectively analyzed to evaluate treatment practices before the implementation of the ATA guidelines.
Results:
We included 216 pediatric patients with DTC. A majority were female (76%) with a median age at diagnosis of 14.8 years. Neck swelling (56%) and palpable nodules (49%) were common presenting symptoms. Diagnostic evaluations typically included thyroid ultrasound, with common features being microcalcifications (47.7%) and hypoechogenicity (39.0%). Fine-needle aspiration cytology confirmed diagnosis in 50.5%. The majority of patients underwent total thyroidectomy (78.7%) and lymph node dissection (75.5%). ATA risk stratification was low, intermediate, and high risk in 111 (51.4%), 29 (13.4%), and 76 patients (35.2%), respectively. Upfront radioactive iodine (RAI) was administered in 83%. At 1-year follow-up, 46% were disease-free (66% low risk, 59% intermediate risk, and 13% high risk). The 5-year progression-free survival for low, intermediate, and high risk were 86%, 53%, and 43%, respectively. The disease-related overall survival was 100%.
Conclusions:
Prior to the introduction of the ATA guidelines, a majority of patients underwent total thyroidectomy with lymph node dissection followed by RAI. Selective use of RAI for low-risk disease as recommended in the current guidelines may be appropriate.
