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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] [What about the content of this article? (0)] [Affiliation(s)] [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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