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Singh SS, Mittal BR, Sood A, Bhattacharya A, Kumar G, Shekhawat AS, Singh H. Applicability of Adults 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines for Postoperative Risk Stratification and Postradioiodine Treatment Dynamic Risk Stratification in Pediatric Population. World J Nucl Med 2022; 21:127-136. [PMID: 35865163 PMCID: PMC9296250 DOI: 10.1055/s-0042-1750334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose
This retrospective study aimed to study the applicability of 2015 adult American Thyroid Association (ATA) differentiated thyroid cancer (DTC) postoperative risk stratification and guidelines in the pediatric population for evaluating the number of metastatic lymph nodes in the postoperative risk stratification and postradioactive iodine (RAI) treatment dynamic risk stratification (DRS) using response to treatment (RTT) reclassification. In addition, the effect of pubertal status and gender was assessed on disease presentation and prognosis.
Methods
Data of 63 DTC patients aged 20 years or less, stratified into prepubertal, pubertal, and postpubertal age groups, was divided into low, intermediate, and high-risk groups using pediatric ATA recurrence risk stratification. Forty-seven patients were classified as responders (excellent and indeterminate responses) and incomplete responders (biochemical and structurally incomplete responses) by assessing the RTT at 1.5 years follow-up similar to recommendation of 2015 adult DTC ATA guidelines.
Results
Female-to-male ratio showed a trend of gradual increase with increasing age. Significantly more responders were observed in low- and intermediate-risk groups than in high-risk group (
p
= 0.0013;
p
= 0.017, respectively), while prepubertal group had more extensive (N1b) disease. Using DRS at follow-up of 1.5 year, pubertal and postpubertal groups showed significantly better response to RAI. More female than male patients showed response and took significantly less time to respond to RAI (
p
= 0.003).
Conclusion
RAI response in pediatric DTC depends on pubertal status, gender, and number of malignant nodes. DRS using RTT classification may be applicable early at 1.5 years after initial therapy in different pubertal age and risk groups.
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Affiliation(s)
- Shashank Shekhar Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ganesh Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Singh Shekhawat
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harpreet Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Radiation-induced papillary thyroid cancer: is it a distinct clinical entity? Curr Opin Otolaryngol Head Neck Surg 2019; 27:117-122. [PMID: 30664052 DOI: 10.1097/moo.0000000000000522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To present the current status of knowledge regarding radiation-induced papillary thyroid cancer (RIPTC), defining its epidemiologic, pathologic, and clinical characteristics, with ensuing possible therapeutic and prognostic consequences. RECENT FINDINGS Cumulative evidence shows that RIPTC resembles sporadic papillary thyroid cancer (PTC) of comparable age, both in terms of clinical-pathological features and prognosis. Therefore, more aggressive treatment does not seem to be required when managing RIPTC as its prognosis is comparable to that of never-irradiated patients. SUMMARY Radiation exposure in childhood is a well-documented risk factor for development of PTC. Therefore, increased exposure to medical or environmental radiation may be in part responsible, along with increased screening, of the recent burgeoning incidence of PTC. A specific morphological and molecular portrait of RIPTC is unlikely to exist. The more aggressive histologic and clinical features initially reported in radiation-induced cases are consistent with the expectations in nonradiation-related PTC of a comparable age. Aggressive histology, nodal, and distant metastases correlate with early age at onset rather than with radiation exposure. Although relapses are frequent in children, long-term cancer-specific mortality is approximately 1%, lower than that observed for adults and comparable between irradiated and nonirradiated cohorts. RIPTC does not require more aggressive surgery or more adjuvant treatments, as prognosis is as good as that of sporadic PTC when matched for stage and treatment received.
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Zhang XY, Song HJ, Qiu ZL, Shen CT, Chen XY, Sun ZK, Wei WJ, Zhang GQ, Luo QY. Pulmonary metastases in children and adolescents with papillary thyroid cancer in China: prognostic factors and outcomes from treatment with 131I. Endocrine 2018; 62:149-158. [PMID: 30022382 DOI: 10.1007/s12020-018-1678-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) with pulmonary metastases is rare in children and adolescents. Unlike adults, limited data are available on children with this disease. Thus, this study evaluated the therapeutic efficacy and prognostic factors of individuals less than 21 years of age with pulmonary metastases from PTC. METHODS Seventy-six children and adolescents with pulmonary metastases from PTC treated with 131I were retrospectively analyzed. Therapeutic efficacy was evaluated by changes in serum thyroglobulin (Tg) and chest computed tomography (CT). Factors predictive of progression-free survival and overall survival were measured by the Kaplan-Meier method. RESULTS Among the 76 patients included in this study, 22.4% (17 of 76) were less than 15 years old and 65.8% (50 of 76) were female. Under the evaluation of stimulated serum Tg levels, RAI treatment were effective in 55.9% (38 of 68), stable in 26.5% (18 of 68) and ineffectvie in 17.6% (12 of 68) of patients. Changes on anatomical imaging suggested complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 8.5, 62.0, 15.5, and 14.1% of individuals, respectively. Univariate analysis showed that size and tumor doubling time of pulmonary metastases were independent factors affecting therapeutic efficacy. Extra-thyroidal extension, tumor diameter of pulmonary metastases and tumor doubling time were significant independent factors regarding progression-free survival rates, while only tumor doubling time and tumor diameter were significant risk factors associated with overall survival rate. CONCLUSIONS Radioactive iodine therapy is an effective treatment for children and adolescents with pulmonary metastases from PTC. Extra-thyroid extension was associated with disease progression while did not show significant influence on overall survival. Tumor doubling time and tumor diameter were the main factors influencing both progression-free survival and overall survival.
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Affiliation(s)
- Xin-Yun Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
| | - Chen-Tian Shen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Xiao-Yue Chen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhen-Kui Sun
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Wei-Jun Wei
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Guo-Qiang Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
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