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Indian J Cancer. 2018 Jan-Mar;55(1):105-110. doi: 10.4103/ijc.IJC_486_17.

Management outcomes of pediatric and adolescent papillary thyroid cancers with a brief review of literature.

Author information

1
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
2
Department of Epidemiology and Biostatistics and Nuclear Medicine, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

Abstract

Background:

Papillary carcinoma of thyroid (PTC) is a rare disease in children and adolescents and contributes to about 1.5%-3% of all pediatric malignancies. To date, no randomized trial has ever been performed in the pediatric population and management of these patients has been extrapolated from adult practice.

Materials and Methods:

Retrospective analysis of the patients treated for PTC in the age <21 years, between the years 1998-2013 at a tertiary cancer center from India.

Results:

Sixty-seven patients were treated in the above said period with a male:female ratio of 1:1.6 and a median age of 18 years. Fifty-two (77.6%) patients clinically presented as a thyroid swelling with or without nodal swelling while 13 (19.4%) presented with isolated nodal swelling. Surgery was performed in 30 patients at a nononcological hospital and was subsequently referred to our center; more than half of them needed a completion surgery at our center. Pathologically, multifocal tumors were found in close to a quarter of the patients. Among the pathological variants, classical, follicular, and tall cell variants comprised 65.7%, 28.4%, and 5.9% of the cases, respectively. Nodal positivity was noted 71.6% of the cases of which 14.5% were N1a disease and the vast majority (85.5%) harboring N1b disease. The median follow-up period of the study cohort was 104 months during which there were 3 local, 6 nodal, and 2 systemic recurrences. The 5- and 10-year disease-free survival were found to be 85.9% and 81.4%, respectively. Univariate and multivariate analysis has shown no significant clinical and pathological feature defining the disease outcomes except for the T-stage. Logistic regression revealed extrathyroidal invasion and the age ≤ 15 years correlated with nodal positivity.

Conclusion:

Being a rare malignancy, pediatric and adolescent PTCs tend to behave differently from adult PTC with a seemingly aggressive clinical presentation; however, they are associated with excellent survival outcomes.

KEYWORDS:

I-131 therapy; management; papillary thyroid cancer; pediatric cancer; prognosis; survival

PMID:
30147104
DOI:
10.4103/ijc.IJC_486_17
[Indexed for MEDLINE]
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