Manganelli, Mariarosaria (2022) LONG-TERM PROGNOSTIC VALUE OF RESPONSE TO THERAPY ASSESSED 12 MONTHS AFTER RADIOIODINE TREATMENT IN PEDIATRIC PATIENTS WITH DIFFERENTIATED THYRID CANCER. [Tesi di dottorato]

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Abstract

PURPUSE: Differentiated thyroid tumors (DTC) account for 21% of all head and neck cancer in pediatric patients with an increasing incidence rate of approximately 1% annually. Unlike adults, children typically present with advanced disease at diagnosis. In particular, extensive regional nodal involvement and distant metastases are more frequent in children as compared to adult patients. Moreover, disease recurrence after initial treatment occurs more frequently in young patients, leading to a high rate of reoperation. Despite this, prognosis in pediatric patients with DTC is excellent, with an overall survival of 90% at 30 years. Although death from DTC is low, the best treatment strategy in pediatric patients is still debating. According to ATA guidelines, 131-Iodine (131-I) therapy is routinely performed in patients with DTC. In pediatric patients, DTC are usually highly iodine avid, and show an excellent response to radioiodine therapy. Several authors have reported improved survival, decreased disease progression, and lower recurrence rates in those with advanced DTC who received postoperative radio- active iodine (RAI). Aim of this study is to evaluated the prognostic value of the 12-month response to therapy after initial treatment with surgery and radioactive iodine (RAI) in pediatric patients with differentiated thyroid cancer (DTC). METHODS: We retrospectively evaluated 94 pediatric patients with DTC, treated with surgery and RAI who were initially classified as low, intermediate or high risk of recurrence according to the American Thyroid Association (ATA) guidelines. Twelve months after RAI administration the response to therapy was assessed by serum thyroglobulin (Tg) measurement and neck ultrasound and patients were classified as having excellent response (ER) or no-ER. RESULTS: At the 12 months evaluation, 62 (66%) patients had ER and 32 (34%) no-ER. During a mean follow-up time of 86 months (range 9-517), 19 events occurred (20% cumulative event rate). Events occurred more frequently in younger patients (p < 0.05), in those at ATA intermediate/high risk (p < 0.01) and with a pre-RAI therapy Tg level >10 ng/mL (p < 0.001), and in those with no-ER (p < 0.001). At multivariate analysis, the evidence of no-ER was the only independent predictor of events. CONCLUSION: In pediatric patients with DTC, the response to therapy evaluated 12 months after initial treatment has an independent prognostic impact and is able to predict mid-term outcome which very often coincides with the long-term one. Patients with no-ER at 12 months after RAI therapy should be closely followed-up.

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