Conservative surgical approach for thyroid and lymph-node involvement in papillary thyroid carcinoma of childhood and adolescence

Maura Massimino, Paola Collini, Silvia Fagundes Leite, Filippo Spreafico, Nicola Zucchini, Andrea Ferrari, Franco Mattavelli, Ettore Seregni, Maria Rita Castellani, Giulio Cantù, Franca Fossati-Bellani, Juan Rosai

Research output: Contribution to journalArticle

Abstract

Background. Prior to 1990s, papillary thyroid carcinomas (PTCs) in childhood/adolescence underwent a standard therapeutic approach (total thyroidectomy plus elective neck dissection, followed by radioactive iodine (RAI) ablation), with an overall survival of about 100%. The aim of this study is to outline the possibility of a conservative approach (hemithyroidectomy plus selective neck dissection of clinically involved nodes, followed by TSH-suppressive therapy) in a selected group of patients. Procedure. From 1968 to 2001, 42 pediatric PTC patients were treated at our institution. Absence of distant metastases and a tumor clinically limited to one lobe were both present in 28 cases that underwent a radical (20 cases) or a conservative (8 cases) surgical approach at the thyroid level. At cervical node level, 10 patients underwent a radical and 32 a conservative surgical approach. Clinicopathologic features at onset, type of therapy (radical vs. conservative), post-operative complications, and outcome till May 31, 2004 were recorded. The impact of the type of surgery on outcome was evaluated. Results. Overall and progression-free survival (PFS) curves were found to be independent of the type of therapy (radical vs. conservative) in subgroups of patients matched for extent of disease at onset. Post-operative complications occurred only with radical surgical approaches. Conclusions. Childhood and adolescence PTCs show a high rate of spread but an excellent outcome independent of the type of therapy (radical vs. conservative). Taking into account the marked responsiveness to TSH-suppression and the complications after radical therapy, in selected cases, a conservative approach should be considered, reserving more aggressivetherapies in case of metastases or relapse.

Original languageEnglish
Pages (from-to)307-313
Number of pages7
JournalPediatric Blood and Cancer
Volume46
Issue number3
DOIs
Publication statusPublished - Mar 2006

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Thyroid Gland
Lymph Nodes
Neck Dissection
Therapeutics
Neoplasm Metastasis
Thyroidectomy
Iodine
Disease-Free Survival
Papillary Thyroid cancer
Pediatrics
Recurrence
Survival
Neoplasms

Keywords

  • Adolescence
  • Children
  • Papillary thyroid carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Conservative surgical approach for thyroid and lymph-node involvement in papillary thyroid carcinoma of childhood and adolescence. / Massimino, Maura; Collini, Paola; Leite, Silvia Fagundes; Spreafico, Filippo; Zucchini, Nicola; Ferrari, Andrea; Mattavelli, Franco; Seregni, Ettore; Castellani, Maria Rita; Cantù, Giulio; Fossati-Bellani, Franca; Rosai, Juan.

In: Pediatric Blood and Cancer, Vol. 46, No. 3, 03.2006, p. 307-313.

Research output: Contribution to journalArticle

Massimino, Maura ; Collini, Paola ; Leite, Silvia Fagundes ; Spreafico, Filippo ; Zucchini, Nicola ; Ferrari, Andrea ; Mattavelli, Franco ; Seregni, Ettore ; Castellani, Maria Rita ; Cantù, Giulio ; Fossati-Bellani, Franca ; Rosai, Juan. / Conservative surgical approach for thyroid and lymph-node involvement in papillary thyroid carcinoma of childhood and adolescence. In: Pediatric Blood and Cancer. 2006 ; Vol. 46, No. 3. pp. 307-313.
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abstract = "Background. Prior to 1990s, papillary thyroid carcinomas (PTCs) in childhood/adolescence underwent a standard therapeutic approach (total thyroidectomy plus elective neck dissection, followed by radioactive iodine (RAI) ablation), with an overall survival of about 100{\%}. The aim of this study is to outline the possibility of a conservative approach (hemithyroidectomy plus selective neck dissection of clinically involved nodes, followed by TSH-suppressive therapy) in a selected group of patients. Procedure. From 1968 to 2001, 42 pediatric PTC patients were treated at our institution. Absence of distant metastases and a tumor clinically limited to one lobe were both present in 28 cases that underwent a radical (20 cases) or a conservative (8 cases) surgical approach at the thyroid level. At cervical node level, 10 patients underwent a radical and 32 a conservative surgical approach. Clinicopathologic features at onset, type of therapy (radical vs. conservative), post-operative complications, and outcome till May 31, 2004 were recorded. The impact of the type of surgery on outcome was evaluated. Results. Overall and progression-free survival (PFS) curves were found to be independent of the type of therapy (radical vs. conservative) in subgroups of patients matched for extent of disease at onset. Post-operative complications occurred only with radical surgical approaches. Conclusions. Childhood and adolescence PTCs show a high rate of spread but an excellent outcome independent of the type of therapy (radical vs. conservative). Taking into account the marked responsiveness to TSH-suppression and the complications after radical therapy, in selected cases, a conservative approach should be considered, reserving more aggressivetherapies in case of metastases or relapse.",
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AU - Massimino, Maura

AU - Collini, Paola

AU - Leite, Silvia Fagundes

AU - Spreafico, Filippo

AU - Zucchini, Nicola

AU - Ferrari, Andrea

AU - Mattavelli, Franco

AU - Seregni, Ettore

AU - Castellani, Maria Rita

AU - Cantù, Giulio

AU - Fossati-Bellani, Franca

AU - Rosai, Juan

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N2 - Background. Prior to 1990s, papillary thyroid carcinomas (PTCs) in childhood/adolescence underwent a standard therapeutic approach (total thyroidectomy plus elective neck dissection, followed by radioactive iodine (RAI) ablation), with an overall survival of about 100%. The aim of this study is to outline the possibility of a conservative approach (hemithyroidectomy plus selective neck dissection of clinically involved nodes, followed by TSH-suppressive therapy) in a selected group of patients. Procedure. From 1968 to 2001, 42 pediatric PTC patients were treated at our institution. Absence of distant metastases and a tumor clinically limited to one lobe were both present in 28 cases that underwent a radical (20 cases) or a conservative (8 cases) surgical approach at the thyroid level. At cervical node level, 10 patients underwent a radical and 32 a conservative surgical approach. Clinicopathologic features at onset, type of therapy (radical vs. conservative), post-operative complications, and outcome till May 31, 2004 were recorded. The impact of the type of surgery on outcome was evaluated. Results. Overall and progression-free survival (PFS) curves were found to be independent of the type of therapy (radical vs. conservative) in subgroups of patients matched for extent of disease at onset. Post-operative complications occurred only with radical surgical approaches. Conclusions. Childhood and adolescence PTCs show a high rate of spread but an excellent outcome independent of the type of therapy (radical vs. conservative). Taking into account the marked responsiveness to TSH-suppression and the complications after radical therapy, in selected cases, a conservative approach should be considered, reserving more aggressivetherapies in case of metastases or relapse.

AB - Background. Prior to 1990s, papillary thyroid carcinomas (PTCs) in childhood/adolescence underwent a standard therapeutic approach (total thyroidectomy plus elective neck dissection, followed by radioactive iodine (RAI) ablation), with an overall survival of about 100%. The aim of this study is to outline the possibility of a conservative approach (hemithyroidectomy plus selective neck dissection of clinically involved nodes, followed by TSH-suppressive therapy) in a selected group of patients. Procedure. From 1968 to 2001, 42 pediatric PTC patients were treated at our institution. Absence of distant metastases and a tumor clinically limited to one lobe were both present in 28 cases that underwent a radical (20 cases) or a conservative (8 cases) surgical approach at the thyroid level. At cervical node level, 10 patients underwent a radical and 32 a conservative surgical approach. Clinicopathologic features at onset, type of therapy (radical vs. conservative), post-operative complications, and outcome till May 31, 2004 were recorded. The impact of the type of surgery on outcome was evaluated. Results. Overall and progression-free survival (PFS) curves were found to be independent of the type of therapy (radical vs. conservative) in subgroups of patients matched for extent of disease at onset. Post-operative complications occurred only with radical surgical approaches. Conclusions. Childhood and adolescence PTCs show a high rate of spread but an excellent outcome independent of the type of therapy (radical vs. conservative). Taking into account the marked responsiveness to TSH-suppression and the complications after radical therapy, in selected cases, a conservative approach should be considered, reserving more aggressivetherapies in case of metastases or relapse.

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