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Children Thyroid Cancer treatment in Saint-Petersburg Endocrine SurgeryCenter and Mayo Clinic

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Abstract


Introduction

Thyroid cancer (TC) is the most often malignant tumor in childhood and made 1.5 – 3.0% of all children population or 45.3% of pediatric endocrine epithelial cancers. A lot of questions concerning to volume of thyroid surgery, postoperative radio iodine therapy (RIT) needs to be discussed.

Aim

Estimation of childhood sporadic thyroid cancer specificity and comparison of children and adolescents treatment in Saint-Petersburg Endocrine Surgery Center (Russia) and Mayo Clinic (USA).

Material and methods

During 1970 –2011 in the Saint-Petersburg Center (1 group) were operated 105 TC children and adolescent (up to 20 yeas) and in Mayo Clinic – 188 (2 group) in  1940 – 2000 period. Since of 80-s in those clinics were used the same perioperative examinations, like TSH, T4, T3 blood levels, USG, fine needles aspiration biopsy, CT and morphological examinations.

Results and discussion

Average age of the Saint-Petersburg Center and Rochester patients was the same and achieve 16.3±0.3 and 16.0±0.5, accordingly. In both groups has prevailed girls: in the 1 group they made 73.3% (M:F 1:2.7) and in the 2 – 70.7% (M:F 1:2.4). Childhood differentiated TC were associated with aggressive behavior: regional metastases were found in 53.0% and 81.4%, extrathyroid TC spreading – in 9.6 and 19.7%, distant metastases - in 9.6 and 4.8%, accordingly. In our Center (1 group) we have performed hemithyroidectomies and subtotal Thyroidectomies in 58.1% with ipsilateral central neck dissection (CND). In Mayo Clinic in all TC cases were performed thyroidectomy (TE) since 1950. TC relapses we have no   observed in 1 group and they have place in 6.9% 2 group patients, recurring lymphatic metastases – in 8.4% and 20.7%, accordingly. Radioiodine therapy (RIT) has performed in 21.1% and 25.5% operated children.

In 1 group 95 (96.0 %) of 99 operated were alive during 5 – 36 years, in the 2– only in two cases reason of death was TC, but in 14 – other malignant tumor.

Conclusion

Childhood TC is associated with more locally aggressive and more frequent distant disease than its in adult coun­terpart. Recurrence rate stend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood TC should include TE and CND. RIT in child hood has in creased possibility of others malignant tumor in follow up period.


Aleksandr Filippovich Romanchishen

Saint-Petersburg State Pediatric Medical University

Author for correspondence.
Email: afromanchishen@mail.ru

Russian Federation MD, PhD, Professor

Geoffrey B. Thompson

Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Email: Thompson.geoffrey@mayo.edu

United States M.D., Professor of Surgery

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