Differentiated Thyroid Cancer in Adolescents: Single Center Experience and Considerations for Surgical Management and Radioiodine Treatment
Costanza Chiapponi1, Milan Janis Michael Hartmann1, Boris Decarolis2, Thorsten Simon2, Christiane Josephine Bruns1, Michael Faust3, Anne Maria Schultheis4, Matthias Schmidt5, Hakan Alakus11University Hospital Cologne, Department of General, Visceral, Cancer and Transplant Surgery, Cologne, Germany2University Hospital Cologne, Department of Pediatric Oncology, Cologne, Germany
3University Hospital Cologne, Centre for Endocrinology, Diabetes and Preventive Medicine, Cologne, Germany
4University Hospital Cologne, Department of Pathology, Cologne, Germany
5University Hospital Cologne Faculty of Medicine, Department of Nuclear Medicine, Cologne, Germany
INTRODUCTION: Differentiated thyroid cancer (DTC) in adolescents rare but with a favorable outcome, despite higher rates of cervical lymph node and pulmonary metastasis compared to adults. The aim of this study was to critically evaluate treatment of adolescents with DTC at a single center.
METHODS: Patients receiving postoperative radioiodine treatment (RAIT) for DTC between 2005 and 2020 at our institution were screened to identify adolescents according to the World Health Organization definition (10-19 years of age). Demographics, clinico-pathological characteristics, treatment and outcome were analyzed.
RESULTS: Among 1,897 DTC patients, 23 (1.3%) were adolescents with a median (range) age of 16 (10-18) years. The female to male ratio was 3.6: 1. Sixty percent had classic papillary thyroid cancer, with follicular variant in 40%, which was higher than previously reported (15-25%) for this age group. pT-status was pT1 in 9 (39.2%), pT2 in 8 (34.8%), pT3 in 3 (13%) and pT4 in 3 (13%) patients. In 19 (82.6%) patients, central lymphadenectomy was performed and metastasis was seen in 57%. All patients received RAIT with initial activities of 1.2 (n=1, 4.3%), 2 (n=12, 52.2%) or 3.7 GBq (n=10, 43.5%). Eighteen (78.2%) patients were free of biochemical and radiologic disease at a median follow-up of 60.7 months. Second-line surgery for lymph node relapse was necessary in 3 (13%) cases. There was one disease-associated death.
DISCUSSION AND CONCLUSION: Despite high rates of metastasis, most patients were cured, and second-line surgery was rarely required. Further prospective studies are needed to determine whether less aggressive surgical management or omitting adjuvant RAIT are feasible in patients with limited stages at diagnosis.
Manuscript Language: English
