Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer
BACKGROUND: Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients. OBJECTIVE: The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy. METHODS: Sixty-five patients, treated in two tertiary-care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor-Node- Metastasis; Age-Metastasis-Extracapsular-Size; distant Metastasis-Age-Completeness of primary tumor resection-local Invasion-Size and American-Thyroid-Association classification RESULTS: Patients ages ranged from 4 to 20 years (median 14). The mean follow-up was 12,6 years. Lymph node metastasis was found in 61.5% and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease-free status in follow-up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy. CONCLUSIONS: Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer.
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2011
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oai:scielo:S1807-593220110002000172011-03-31Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancerVaisman,FernandaBulzico,Daniel AlvesPessoa,Cencita Hosannah Cordeiro NoronhaBordallo,Maria Alice NevesMendonça,Ullyanov Bezerra Toscano deDias,Fernando LuizCoeli,Claudia MedinaCorbo,RossanaVaisman,Mario Thyroid cancer Response to therapy Radioactive-iodine Staging system Childhood BACKGROUND: Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients. OBJECTIVE: The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy. METHODS: Sixty-five patients, treated in two tertiary-care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor-Node- Metastasis; Age-Metastasis-Extracapsular-Size; distant Metastasis-Age-Completeness of primary tumor resection-local Invasion-Size and American-Thyroid-Association classification RESULTS: Patients ages ranged from 4 to 20 years (median 14). The mean follow-up was 12,6 years. Lymph node metastasis was found in 61.5% and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease-free status in follow-up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy. CONCLUSIONS: Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer.info:eu-repo/semantics/openAccessFaculdade de Medicina / USPClinics v.66 n.2 20112011-01-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322011000200017en10.1590/S1807-59322011000200017 |
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Vaisman,Fernanda Bulzico,Daniel Alves Pessoa,Cencita Hosannah Cordeiro Noronha Bordallo,Maria Alice Neves Mendonça,Ullyanov Bezerra Toscano de Dias,Fernando Luiz Coeli,Claudia Medina Corbo,Rossana Vaisman,Mario |
spellingShingle |
Vaisman,Fernanda Bulzico,Daniel Alves Pessoa,Cencita Hosannah Cordeiro Noronha Bordallo,Maria Alice Neves Mendonça,Ullyanov Bezerra Toscano de Dias,Fernando Luiz Coeli,Claudia Medina Corbo,Rossana Vaisman,Mario Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
author_facet |
Vaisman,Fernanda Bulzico,Daniel Alves Pessoa,Cencita Hosannah Cordeiro Noronha Bordallo,Maria Alice Neves Mendonça,Ullyanov Bezerra Toscano de Dias,Fernando Luiz Coeli,Claudia Medina Corbo,Rossana Vaisman,Mario |
author_sort |
Vaisman,Fernanda |
title |
Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
title_short |
Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
title_full |
Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
title_fullStr |
Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
title_full_unstemmed |
Prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
title_sort |
prognostic factors of a good response to initial therapy in children and adolescents with differentiated thyroid cancer |
description |
BACKGROUND: Therapeutic approaches in pediatric populations are based on adult data because there is a lack of appropriate data for children. Consequently, there are many controversies regarding the proper treatment of pediatric patients. OBJECTIVE: The present study was designed to evaluate patients with differentiated thyroid carcinoma diagnosed before 20 years of age and to determine the factors associated with the response to the initial therapy. METHODS: Sixty-five patients, treated in two tertiary-care referral centers in Rio de Janeiro between 1980 and 2005 were evaluated. Information about clinical presentation and the response to initial treatment was analyzed and patients had their risk stratified in Tumor-Node- Metastasis; Age-Metastasis-Extracapsular-Size; distant Metastasis-Age-Completeness of primary tumor resection-local Invasion-Size and American-Thyroid-Association classification RESULTS: Patients ages ranged from 4 to 20 years (median 14). The mean follow-up was 12,6 years. Lymph node metastasis was found in 61.5% and indicated a poor response to initial therapy, with a significant impact on time for achieving disease free status (p = 0.014 for response to initial therapy and p<0,0001 for disease-free status in follow-up). Distant metastasis was a predictor of a poor response to initial therapy in these patients (p = 0.014). The risk stratification systems we analyzed were useful for high-risk patients because they had a high sensitivity and negative predictive value in determining the response to initial therapy. CONCLUSIONS: Metastases, both lymph nodal and distant, are important predictors of the persistence of disease after initial therapy in children and adolescents with differentiated thyroid cancer. |
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Faculdade de Medicina / USP |
publishDate |
2011 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322011000200017 |
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