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The Indian Journal of Pediatrics

, Volume 70, Issue 9, pp 707–713 | Cite as

Differentiated thyroid cancer

  • Ajay Kumar
  • C. S. Bal
Original Article

Abstract

Objective: The retrospective analysis of the case files of children with differentiated thyroid carcinoma (DTC) was performed to define the disease by its presentation, clinical course and outcome of radioiodine therapy.Methods: Between 1967 to October 2002,1754 patients with thyroid cancer were treated in the Dept of Neuclear Medicine, AIIMS, out of which 122 (7%) were ≶ 20 years of age (71 girls and 51 boys). The mean age was 15.8 ± 3.6 years and the mean duration of follow-up was 90 ± 59.3 months. Mean tumor size was 4.4 cm. Histologically, 85% of the patients had papillary and rest follicular carcinoma. Cervical lymph node involvement was seen in 64%, and distant metastases, mainly pulmonary, in 23% of the patients. The presentation of the disease was very aggressive in the first decade of life with male preponderance. All but one patient in this age group had nodal and/or distant metastases; in 83.3% the disease had spread to the lymph nodes and 67% had metastases to the lungs. The post-surgery 48-hour mean radioiodine neck uptake was 10.5 ± 7.6%.Results: 94% of the residual thyroid, 88% of nodal metastases and 71% of pulmonary metastases were ablated requiring mean cumulative doses of 2.8 ± 2.7 GBq, 4.5 ± 2.7 GBq and 10.4 ± 7.9 GBq of131I, respectively. Average number of doses required for remnant, nodal and pulmonary metastases ablation were 1.3, 2.2 and 3.3, respectively. 80% of the patients with only remnant thyroid tissue and 50% with cervical lymph node metastases got ablated with a single dose of131I. Overall, 87% patients were currently free of disease. While, nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter and 3 disease related deaths producing overall mortality of 2.5% (all in children ≶10 years of age) were seen in the mean follow-up of 7.5 years.Conclusion: Differentiated thyroid cancer in children and adolescents is rare but aggressive. The biological behavior differs from that in adults and is related to the age. Younger the age (≶10 years), more aggressive and widespread is the disease with male preponderance and high mortality. The Post-surgical radioiodine ablation/therapy is an important and effective adjuvant in the management of DTC in children and adolescents and even though they present with advance disease, long-term survival and overall prognosis is good.

Keywords

Childhood thyroid cancer Radioiodine ablation 

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References

  1. 1.
    Young J, Percy C. Surveillance, epidemiology and end results: Incidence and mortality data.NCI Monog 1981; 57:1973–1977.Google Scholar
  2. 2.
    Brennan MF, MaCdonald JS. Cancer of endocrine system. In De Vita VT, Hellman S, Rosenberg SA, eds.Cancer Principles and Practice of Oncology. Philadelphia: J.B. Lippincot, 1985: 1179–1192.Google Scholar
  3. 3.
    Buckwalter JA, Guril NJ, Thomas CG. Cancer of the thyroid in youth.World J Surg 1981; 5:15–25.PubMedCrossRefGoogle Scholar
  4. 4.
    Fassina AS, Rupolo M, Pelizzo MR, Casara D. Thyroid cancer in children and adolescents.Tumori 1994; 80: 257–262.PubMedGoogle Scholar
  5. 5.
    Aune BB. Thyroid neoplasms. In Stacker JT, Dehner LP, eds.Pediatric Pathology, Lippincott; Philadelphia 1992; 976–980.Google Scholar
  6. 6.
    Desjardins JG, Bass J, Leboeuf G. A twenty year experience with thyroid carcinoma in children.Pediatr Surg 1988; 23: 709–713.CrossRefGoogle Scholar
  7. 7.
    Merrick Y, Hansen HS. Thyroid cancer in children and adolescents in Denmark.Eur J Surg Oncol 1989; 15:49–53.PubMedGoogle Scholar
  8. 8.
    Mosso ML, Colombo R, Giordano Let al. Childhood cancer registry of the province of Torino, Italy: Survival, incidence and mortality over 20 years.Cancer 1992; 69:1300–1306.PubMedCrossRefGoogle Scholar
  9. 9.
    Zimmerman D, Hay ID, Ian Ret al. Papillary thyroid carcinoma in children and adults: Long-term follow-up of 1039 patients conservatively treated at one institution during three decades.Surgery 1988; 104:1157–1166.PubMedGoogle Scholar
  10. 10.
    Rosen IB, Bowden I, Luk SC, John AS. Aggressive thyroid cancer in low risk age population.Surgery 1987; 102: 1075–1080.PubMedGoogle Scholar
  11. 11.
    Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma.Surgery 1988; 104:947–953.PubMedGoogle Scholar
  12. 12.
    La Quaglia MP, Black T, Holcomb G W 3rd, Sklar C, Azizkhan R G, Hasse G M. Differentiated thyroid cancer: clinical characteristics, treatment, and outcome in patients under 21 years of age who presented with distant metastases. A report from the surgical discipline committee of the children’s cancer group.J Paed Surg 2000; 35:955–960.CrossRefGoogle Scholar
  13. 13.
    Bal CS, Padhy AK, Jana S, Pant GS, Basu AK. Prospective randomized clinical trial to evaluate the optimal dose of131I for remnant ablation in patients with differentiated thyroid carcinoma.Cancer 1996; 77: 2574–2580.PubMedCrossRefGoogle Scholar
  14. 14.
    Heidinger LE, Sobin LH. International histological classification of tumors. Geneva: World Health Organisation 1974; 17–26.Google Scholar
  15. 15.
    Exelby PE, Frazell E L. Carcinoma of the thyroid in children.Surg Clin North Amer 1969; 49:249–259.Google Scholar
  16. 16.
    Liechty RD, Safaie-shirazi S, Soper RT. Carcinoma of the thyroid in children.Surg Gynae Obstet 1972; 134: 595–599.Google Scholar
  17. 17.
    Buckwalter JA, Thomas CG, Freemen JB. Is childhood thyroid cancer a lethal disease?Ann Surg 1975; 181: 632–639.PubMedCrossRefGoogle Scholar
  18. 18.
    Withers EH, Rosenfeld L, O’Neil JLet al. Long-term experience with childhood thyroid carcinoma.J Pediatr Surg 1979; 14: 332–335.PubMedCrossRefGoogle Scholar
  19. 19.
    Zohar Y, Strauss M, Laurian N. Adolesent verses adult thyroid carcinoma.Laryngoscope 1981; 96: 555–559.CrossRefGoogle Scholar
  20. 20.
    Goepfert H, Dichtel WJ, Samaan NA. Thyroid cancer in children and teenagers.Arch Otolaryngol 1984; 110: 72–75.PubMedGoogle Scholar
  21. 21.
    Tallroth E, Backdahl A, Einhom Wet al. Thyroid carcinoma in children and adolescents.Cancer 1986; 58:2329–2332.PubMedCrossRefGoogle Scholar
  22. 22.
    Schlumberger M, De Vathaire F, Travagli Pet al. Differentiated thyroid carcinoma in childhood: Long-term follow-up of 72 patients.J Clin Endocrinol Metab 1987; 65:1088–1094.PubMedCrossRefGoogle Scholar
  23. 23.
    La QuagUa MP, Corbally M T, Heller Get al. Recurrence and morbidity in differentiated thyroid carcinoma in children.Surgery 1988; 104:1149–56.Google Scholar
  24. 24.
    Ceccarelli C, Pacini F, Lippi Fet al. Thyroid cancer in children and adolescents.Surgery 1988; 104:1143–1148.PubMedGoogle Scholar
  25. 25.
    Frankenthaler RA, Sellin RV, Cangir A, Goepfert H. Lymph node metastases from papillary-follicular thyroid carcinoma in young patients.Am J Surg 1990; 160:341–343.PubMedCrossRefGoogle Scholar
  26. 26.
    Mazzaferri EL, JhiangSM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.Am J Med 1994; 97:418–427.PubMedCrossRefGoogle Scholar
  27. 27.
    Massimino M, Gasparini M, Ballerini E, Delbo R. Primary thyroid carcinoma in children: A retrospective study of 20 patients.Med Pediat Oncol 1995; 24:13–17.CrossRefGoogle Scholar
  28. 28.
    Gyorgy Balazs, Geza Lukas, Ferenc Juhasz, Ferenc Gyory, Eva Olah, Erzsebet Balogh. Special Features of Childhood and Juvenile Thyroid Carcinomas. JpnJ Sug 1996; 26:536–540.Google Scholar
  29. 29.
    Catherine A, Welch Dinauer R. Michael Tuttletet al. Clinical features associated with metastases and recurrence of differentiated thyroid cancer in children, adolescents and young adults.Clin Endocrinol 1997; 49:619–628.Google Scholar
  30. 30.
    Segal A, A Rad-Cohen, S Mechlis, E Lubin, R Feinmesser. Cancer of thyroid in children and adolescents.Clin Otolaryngol 1997; 22:525–528.PubMedCrossRefGoogle Scholar
  31. 31.
    D Danese, A Gardini A, Farsetti S, Sciacchitano M, Andreoli A P. Thyroid carcinoma in children and adolescents.Eur J Pediatr 1997; 156:190–194.PubMedCrossRefGoogle Scholar
  32. 32.
    AM Samuel, DH Shah. Differentiated Thyroid Cancer in Childhood and Adolescence. In D.H. Shah, A.M. Samuel, R.S. Rao, eds.Thyroid Cancer: An Indian Perspective; Mumbai: Quest Publications, 1999:535–562.Google Scholar
  33. 33.
    Jarzab B, Kalemba B, Handkiewiez, Junak D, Wtoch J, Roskosz J. Treatment of differentiated thyroid carcinoma in children and young adults: a multivariate analysis.Eur J Nucl Med 1999; 26:98–111.Google Scholar
  34. 34.
    Abelin T, Averkin JI, Egger Met al. Thyroid cancer in Belarus post-Chernobyl: Improved detection or increased incidence?Soz Prdventiv Med 1994; 39:189–197.CrossRefGoogle Scholar
  35. 35.
    Furmanchuk AW, Averkin JI, Eglolff Bet al. Pathomor-phological findings in thyroid cancers of children from the Republic of Belarus: A study of 86 cases occurring between 1986 (“Post Chernobyl”) and 1991.Histopathology 1992; 21: 401–108.PubMedCrossRefGoogle Scholar
  36. 36.
    Hamilton TE, Van Belle G, Lo Gerfo J P. Thyroid neoplasia in Marshall Islanders exposed to nuclear fallout.J Am Med Assoc 1987; 258:629–636.CrossRefGoogle Scholar
  37. 37.
    Kingman S. Thyroid cancer rises after Chernobyl.Br Med J 1992; 305:601–602.CrossRefGoogle Scholar
  38. 38.
    Socolov EL, Hashizume A, Neriishi S, Nitami R. Thyroid carcinoma in man after exposure to ionizing radiation. A summary of the findings in Hiroshima and Nagasaki.New Eng J Med 1963;268:406–410.CrossRefGoogle Scholar
  39. 39.
    Bal CS, Padhy AK. and Kumar A. Clinical features of differentiated thyroid carcinoma in children and adolescents from a sub-Himalayan iodine-deficient endemic zone.Nucl Med Commun 2001; 22; 881–887.PubMedCrossRefGoogle Scholar
  40. 40.
    Lamberg BA, Karkinen-Jaaskelainen M, Franssila KO. Differentiated follicle-derived thyroid carcinoma in children.Acta Pediatr Scand 1989; 78:419–425.Google Scholar
  41. 41.
    Samuel AM, Rajashekharrao B, Shah DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer.J Nucl Med 1998; 39:1531–1536.PubMedGoogle Scholar
  42. 42.
    Hayles AB, Kennedy RJ, Beahrs OH. Management of the child with thyroid cancer.J Am Med Assoc 1960; 173:21–28.PubMedGoogle Scholar
  43. 43.
    Winship T, Rosvoll RV. Thyroid carcinoma in childhood: Final report on a 20-years study.Clin Proc Children Hospital (Washington, DC) 1970; 26:327.Google Scholar
  44. 44.
    Dottorini ME, Vignati A, Mazzucchelli Let al. Differentiated thyroid carcinoma in children and adolescents: A 37-year-experience in 85 patients.J Nucl Med 1997; 38:669–675.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2003

Authors and Affiliations

  1. 1.Department of Nuclear MedicineAll India Institute of Medical SciencesNew DelhiIndia

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