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Toraih E, Webster A, Pineda E, Pinion D, Baer L, Persons E, Herrera M, Hussein M, Kandil E. Radioactive iodine ablation therapy reduces the risk of recurrent disease in pediatric differentiated thyroid carcinoma. Surg Oncol 2024; 56:102120. [PMID: 39154543 DOI: 10.1016/j.suronc.2024.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 07/20/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND While radioactive iodine (RAI) therapy in older adults with differentiated thyroid carcinoma (DTC) reduces recurrence, data in pediatrics remain limited. We conducted a meta-analysis to quantify outcomes and recurrence risk with RAI versus thyroidectomy alone in the pediatric population. METHODS Systematic literature review identified 34 retrospective studies including 2913 DTC patients under age 22 years (published 2005-2023). Meta-analysis calculated pooled rates of disease persistence and recurrence. Relative risk ratios compared odds of recurrence with RAI versus no RAI. RESULTS Patients had mean age 14.7 years (95 % CI, 14.2-15.2) and were 75.9 % female (95 % CI, 73.8-78.1 %). Majority (90.2 %) received RAI. Pooled persistence rate was 30.3 % (95 % CI, 21.7-39.5 %); higher with RAI (31.5 %; 95 % CI, 22.4-41.3 %) than no RAI (4.5 %; 95 % CI, 0.0-18.7 %) (OR 3.28; 95 % CI,1.82-5.91; p < 0.001). Recurrence rate was 8.97 % (95 % CI, 4.78-14.3 %). Those with RAI had 53.1 % lower recurrence risk versus no RAI (RR 0.47; 95 % CI, 0.27-0.82; p = 0.007). Median follow-up was 7.2 years (95 % CI, 5.8-8.5 years), with no association between follow-up duration and recurrence (r = -0.053; p = 0.80). CONCLUSIONS RAI therapy as an adjunct to thyroidectomy is associated with a significantly lower risk of long-term recurrence in pediatric DTC. These findings advocate for the use of RAI in preventing recurrence among high-risk pediatric patients with DTC.
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Affiliation(s)
- Eman Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Alyssa Webster
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Eric Pineda
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Dylan Pinion
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Lily Baer
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Emily Persons
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Marcela Herrera
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Mohammad Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA; Ochsner Clinic Foundation, New Orleans, LA, 70121, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
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Jiang Y, Sun X, Jiang M, Min H, Wang J, Fu X, Qi J, Yu Z, Zhu X, Wu Y. Impact of a mobile health intervention based on multi-theory model of health behavior change on self-management in patients with differentiated thyroid cancer: protocol for a randomized controlled trial. Front Public Health 2024; 12:1327442. [PMID: 38282759 PMCID: PMC10808536 DOI: 10.3389/fpubh.2024.1327442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Theoretical models of health behavior are important guides for disease prevention and detection, treatment and rehabilitation, and promotion and maintenance of physical and mental health, but there are no intervention studies related to differentiated thyroid cancer (DTC) that use theoretical models of health as a guide. In this study, we used a microblogging platform as an intervention vehicle and mobile patient-doctor interactive health education as a means of intervention, with the aim of improving the health behaviors of DTC patients as well as the corresponding clinical outcomes. Methods This research project is a quantitative methodological study, and the trial will be a single-blind, single-center randomized controlled trial conducted at the Fourth Hospital of Harbin Medical University in Harbin, Heilongjiang Province. The study subjects are patients over 18 years of age with differentiated thyroid cancer who were given radioactive iodine-131 therapy as well as endocrine therapy after radical surgery for thyroid cancer. The intervention group will receive MTM-mhealth, and the realization of health education will rely on the smart terminal WeChat platform. Routine discharge education will be given to the control group at discharge. The primary outcome will be change in thyroid-stimulating hormone (TSH) from baseline and at 3 and 6 months of follow-up, and secondary outcomes will include change in self-management behavior, social cognitive and psychological, and metabolic control. Discussion This study will explore a feasible mHealth intervention program applied to a population of DTC patients using the Multi-theory model of health behavior change (MTM) as a guide, with the aim of evaluating the MTM-based intervention program for clinical outcome improvement in DTC patients, as well as determining the effectiveness of the MTM-based intervention program in improving self-management skills in DTC patients. The results of this study will indicate the feasibility as well as the effectiveness of the application of health theoretical modeling combined with mHealth applications in disease prognostic health management models, and provide policy recommendations and technological translations for the development of mobility-based health management applications in the field of health management.
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Affiliation(s)
- Yang Jiang
- Jitang College, North China University of Science and Technology, Tangshan, China
| | - Xiangju Sun
- Clinical Pharmacy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Maomin Jiang
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Jing Wang
- School of Public Health, Peking University, Beijing, China
| | - Xinghua Fu
- The Fourth School of Clinical Medicine, Harbin Medical University, Harbin, China
| | - Jiale Qi
- School of Journalism and Communication, Zhengzhou University, Zhengzhou, China
| | - Zhenjie Yu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaomei Zhu
- Department of Pharmacy, Beidahuang Group General Hospital, Harbin, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
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Bojarsky M, Baran JA, Halada S, Isaza A, Zhuang H, States L, Grant FD, Robbins S, Sisko L, Ricarte-Filho JC, Kazahaya K, Adzick NS, Mostoufi-Moab S, Bauer AJ. Outcomes of ATA Low-Risk Pediatric Thyroid Cancer Patients Not Treated With Radioactive Iodine Therapy. J Clin Endocrinol Metab 2023; 108:3338-3344. [PMID: 37265226 PMCID: PMC10655549 DOI: 10.1210/clinem/dgad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
CONTEXT The American Thyroid Association (ATA) Pediatric Guidelines recommend patients not receive radioactive iodine therapy (RAIT) for differentiated thyroid cancer (DTC) confined to the thyroid. Since publication, there is ongoing concern whether withholding RAIT will result in a lower rate of remission. OBJECTIVE This study explores whether ATA low-risk patients treated with and without RAIT achieved similar remission rates. METHODS Medical records of patients <19 years old diagnosed with DTC and treated with total thyroidectomy between 2010 and 2020 were reviewed. Multivariate logistic regression was performed to evaluate factors influencing RAIT administration and remission rate. RESULTS Ninety-five patients with ATA low-risk DTC were analyzed: 53% (50/95) and 47% (45/95) were treated with and without RAIT, respectively. RAIT was used to treat 82% of patients before 2015 compared with 33% of patients after 2015 (P < .01). No significant difference in 1-year remission rate was found between patients treated with and without RAIT, 70% (35/50) vs 69% (31/45), respectively. With longer surveillance, remission rates increased to 82% and 76% for patients treated with and without RAIT, respectively. Median follow-up was 5.8 years (IQR 4.3-7.9, range 0.9-10.9) and 3.6 years (IQR 2.7-6.6; range 0.9-9.3) for both cohorts. No risk factors for persistent or indeterminate disease status were found, including RAIT administration, N1a disease, and surgery after 2015. CONCLUSION Withholding RAIT for pediatric patients with ATA low-risk DTC avoids exposure to radiation and does not have a negative impact on remission rates. Dynamic risk stratification at 1-year after initial treatment is a suitable time point to assess the impact of withholding RAIT for these patients.
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Affiliation(s)
- Mya Bojarsky
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Julia A Baran
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Stephen Halada
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Amber Isaza
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Hongming Zhuang
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lisa States
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Section Oncologic Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Frederick D Grant
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Stephanie Robbins
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lindsay Sisko
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Julio C Ricarte-Filho
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - N Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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