Mechteld C de Jong1, Mark N Gaze2, Elwira Szychot2, Virginia Rozalén García3, Caroline Brain4, Mehul Dattani4, Helen Spoudeas4, Peter Hindmarsh4, Tarek E Abdel-Aziz3, Jamshed Bomanji5, Ananth Shankar2, Sara Stoneham2, Simon Morley6, Tim Beale6, Susan Jawad6, Sofia Otero6, Ian Proctor7, Sepideh Amin7, Gary Butler4, Richard J Hewitt8, Tom R Kurzawinski3. 1. Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom. Electronic address: mechteld.dejong@nhs.net. 2. Department of Oncology, University College London Hospitals and Great Ormond Street Hospital for Children NHS Foundation Trusts, London, United Kingdom. 3. Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom. 4. Department of Paediatric Endocrinology, University College London, Hospitals and Great Ormond Street Hospital for Children NHS Foundation Trusts, London, United Kingdom. 5. Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 6. Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 7. Department of Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 8. Department of Paediatric Ear, Nose and Throat Surgery, Great Ormond Street Hospitals NHS Foundation Trust London, United Kingdom.
Abstract
AIM: Differentiated thyroid cancer (DTC) in children and adolescents is rare and data about its presentation and management are not well known. The aim of this study was to provide evidence of the current practice in the United Kingdom before the launch of the Rare National Paediatric Endocrine Tumours Guidelines (to be published in 2020). METHODS: Seventy-two children and adolescents with DTC (<18 years) who were treated at our institution between 2003 and 2018 were identified and their presentation, treatment and outcomes were reviewed. RESULTS: Median age at presentation was 12.7 years [range: 1-18] and fifty-two (72%) were girls. Fifty (69.4%) children and adolescents presented with a thyroid nodule. Thirteen (18%) had cervical adenopathy and seven of them (54%) underwent an excision biopsy under GA. Eight patients (11%) had evidence of lung metastases at presentation. Twenty-four patients (33%) underwent a hemithyroidectomy and 22 of those had a completion thyroidectomy subsequently, ten (14%) a total thyroidectomy alone and 37 (51%) a total thyroidectomy with lymph nodes dissection. Seventy patients (97%) underwent adjuvant RAI at our institution. The median number of children and adolescents managed per year was five [range: 0-10]. After an overall median follow-up of 40 months, eight patients (11%) had developed recurrent disease. The 1- and 5-year recurrence-free-survival-rates were 93% and 87%, respectively. Overall survival was 100%, with eight children and adolescents (11%) being alive with disease. CONCLUSION: This study confirms that DTC in children and adolescents is uncommon, is frequently advanced at presentation and has considerable recurrence rates. Despite this, overall survival is excellent. Although the work-up was generally appropriate (image-guided cytology), open biopsy for the diagnosis of lymph node involvement was still employed. The introduction of a specific UK guideline for this age-group will likely result in more tailored-made treatment-pathways and thereby hopefully improve quality and outcomes even further. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level IV.
AIM: Differentiated thyroid cancer (DTC) in children and adolescents is rare and data about its presentation and management are not well known. The aim of this study was to provide evidence of the current practice in the United Kingdom before the launch of the Rare National Paediatric Endocrine Tumours Guidelines (to be published in 2020). METHODS: Seventy-two children and adolescents with DTC (<18 years) who were treated at our institution between 2003 and 2018 were identified and their presentation, treatment and outcomes were reviewed. RESULTS: Median age at presentation was 12.7 years [range: 1-18] and fifty-two (72%) were girls. Fifty (69.4%) children and adolescents presented with a thyroid nodule. Thirteen (18%) had cervical adenopathy and seven of them (54%) underwent an excision biopsy under GA. Eight patients (11%) had evidence of lung metastases at presentation. Twenty-four patients (33%) underwent a hemithyroidectomy and 22 of those had a completion thyroidectomy subsequently, ten (14%) a total thyroidectomy alone and 37 (51%) a total thyroidectomy with lymph nodes dissection. Seventy patients (97%) underwent adjuvant RAI at our institution. The median number of children and adolescents managed per year was five [range: 0-10]. After an overall median follow-up of 40 months, eight patients (11%) had developed recurrent disease. The 1- and 5-year recurrence-free-survival-rates were 93% and 87%, respectively. Overall survival was 100%, with eight children and adolescents (11%) being alive with disease. CONCLUSION: This study confirms that DTC in children and adolescents is uncommon, is frequently advanced at presentation and has considerable recurrence rates. Despite this, overall survival is excellent. Although the work-up was generally appropriate (image-guided cytology), open biopsy for the diagnosis of lymph node involvement was still employed. The introduction of a specific UK guideline for this age-group will likely result in more tailored-made treatment-pathways and thereby hopefully improve quality and outcomes even further. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level IV.
Authors: Adam Stenman; Samuel Backman; Klara Johansson; Johan O Paulsson; Peter Stålberg; Jan Zedenius; C Christofer Juhlin Journal: Endocr Relat Cancer Date: 2021-04-29 Impact factor: 5.678
Authors: Sasha R Howard; Sarah Freeston; Barney Harrison; Louise Izatt; Sonali Natu; Kate Newbold; Sabine Pomplun; Helen A Spoudeas; Sophie Wilne; Tom R Kurzawinski; Mark N Gaze Journal: Endocr Relat Cancer Date: 2022-09-07 Impact factor: 5.900