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Survival good, postoperative complications frequent for pediatric DTC
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Survival rates for pediatric differentiated thyroid carcinoma are high; however, about one-third of patients experience adverse effects after surgery, according to study findings.
Therefore, a major priority of treatment should be to reduce treatment-related morbidity, researchers wrote.
Thera P. Links, MD, PhD, professor of endocrinology at the University of Groningen in the Netherlands, and colleagues evaluated data from 170 patients with pediatric differentiated thyroid carcinoma (DTC) diagnosed before age 18 years (median age at diagnosis, 15.6 years) treated in the Netherlands between 1970 and 2013 to evaluate presentation, treatment-related complications and long-term outcomes.
After a median follow-up of 12.5 years, overall survival was 99.4% and extensive follow-up data were available for 169 survivors. Forty-six patients had cervical lymph node metastases and 14 had distant metastases.
All patients underwent total thyroidectomy, and 97% were treated with radioiodine-131. After surgery, 16 patients had transient hypoparathyroidism and 25 had permanent hypoparathyroidism.
Nine patients had persistent disease at last known follow-up, and eight experienced a DTC recurrence.
Lifelong postoperative complications (permanent hypoparathyroidism or recurrent laryngeal nerve injury) were present in 32% of patients.
“Centralization of care for pediatric patients with DTC is crucial to reduce treatment-related damage in this young patient group,” the researchers wrote. “In the near future, treatment for pediatric patients with DTC will be further centralized in one or two hospitals in the Netherlands. Furthermore, the administration of [radioiodine-131] should be weighed very carefully to prevent early and late adverse events.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Andrew J. Bauer, MD
The article by Klein Hesselink and colleagues thoughtfully reviews 43 years of data on the outcome of pediatric differentiated thyroid cancer treated in 39 hospitals across the Netherlands. Similar to previous reports, pediatric patients presented with a high likelihood of metastasis, with 43% found to have regional lymph node metastasis and 13% found to have distal metastasis, but despite the high burden of disease, overall survival was 99.4%. The authors also report that approximately 8% of patients experienced persistent or recurrent disease up to 22 years after initial diagnosis, supporting recommendations for long-term surveillance. Advanced TNM stage was associated with an increased risk for persistent disease, although, interestingly, neither the initial TNM stage nor the thyroid-stimulating hormone level obtained over years of follow-up were associated with altering the risk for recurrent disease. Perhaps the most informative data were the high risk for surgical complications with 32% of patients experiencing lifelong complications, either permanent hypoparathyroidism or recurrent laryngeal nerve damage. The authors are commended for reporting these data and voicing their plans to centralize care to one to two hospitals within the Netherlands. It is wonderful and humbling to see that a national health care system may alter their practice based on the recommendations and intent of the American Thyroid Association management guidelines for children with thyroid nodules and differentiated thyroid cancer, to maintain low disease-specific survival while reducing complications from care.
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