title: Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer.
abstract: We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age <or=18 y.
  
  
  METHODS
  To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at age <or=18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan-Meier and Cox univariate analysis.
  
  
  RESULTS
  During a median follow-up of 82 mo (range, 5-402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was <1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9-280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P = 0.04] and 11 times [P = 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P = 0.02), 3.3 (P = 0.02), and 3.2 (P = 0.02) times, respectively. Age or sex did not correlate with LR risk.
  
  
  CONCLUSIONS
  In DTC patients <or=18 y of age, extensive initial therapy-consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy--is associated with a substantial decrease of DTC LR risk.
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
authors.forename: Daria
authors.initials: D
authors.lastname: Handkiewicz-Junak
authors.forename: Jan
authors.initials: J
authors.lastname: Wloch
authors.forename: Jozef
authors.initials: J
authors.lastname: Roskosz
authors.forename: Jolanta
authors.initials: J
authors.lastname: Krajewska
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kropinska
authors.forename: Lech
authors.initials: L
authors.lastname: Pomorski
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kukulska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Prokurat
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Wygoda
authors.forename: Barbara
authors.initials: B
authors.lastname: Jarzab
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000231:Adenocarcinoma, Papillary / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000293:Adolescent; D018265:Carcinoma, Papillary, Follicular / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012306:Risk; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals