"Radioactive iodine therapy in low-risk pediatric thyroid cancer: universal standard or selective indication?"

Area of Science:

• Oncology
• Pediatrics
• Endocrinology

Background:

• Radioactive iodine (RAI) treatment for low-risk pediatric differentiated thyroid cancer (DTC) remains a subject of debate.
• Current guidelines lack definitive recommendations for RAI use in this specific population.

Purpose of the Study:

• To evaluate and compare the outcomes of RAI-treated versus untreated pediatric patients with low-risk DTC.
• To inform clinical decision-making regarding RAI therapy in young DTC patients.

Main Methods:

• Retrospective review of pediatric low-risk DTC patients (2010-2024) according to American Thyroid Association (ATA) criteria.
• RAI treatment was administered for DTC > 2 cm and/or lymph node involvement.
• Comparison of cytological categories, tumor staging, and disease persistence/recurrence between treated and untreated groups.

Main Results:

• Fifty percent of the cohort (7/14) received RAI treatment.
• RAI-treated patients showed a higher prevalence of TIR5 cytology (71.4%) and T2 stage (85.7%) compared to untreated patients.
• No significant difference in disease persistence or recurrence was observed between the RAI-treated and untreated groups.

Conclusions:

• RAI treatment in low-risk pediatric DTC patients did not demonstrate superior outcomes in terms of disease persistence or recurrence.
• A case-by-case approach, considering individual patient factors, is advisable for managing low-risk pediatric DTC.
• Absolute recommendations for RAI in all pediatric DTC patients may not be appropriate.