The Extent of Disease at Diagnosis Predicts Response to Initial Therapy for Papillary Thyroid Cancer. † 498

Surgery, radioactive iodine (RAI), and thyroid hormone suppression are routinely used to treat children with papillary thyroid cancer (PTC) but there is active debate regarding the extent of surgery, the optimal dose and the timing of RAI ablation. Children commonly present with cervical metastasis, but the mortality rate is low. This has led to speculation that current aggressive treatment is important in reducing mortality. We previously showed that children with metastatic PTC are at greater risk for later recurrence compared to patients without metastases at diagnosis. No pediatric study has yet determined how frequently initial therapy induces a prolonged remission or even cure for patients with metastatic thyroid cancer. In the current study, we determined success of initial treatment in patients with metastatic PTC at diagnosis. We identified 137 children diagnosed with PTC at ≤21yrs of age. Of these, 27 patients received similar initial treatment (subtotal or total thyroidectomy and RAI) and had a well documented response to this treatment. Patients with less extensive disease (Class 2, cervical lymph node metastasis, or Class 3, locally invasive disease) were more likely to be free of disease after initial treatment than patients with distant metastasis (Class 4, p=0.001, linear-by-linear association). These data show that initial therapy with extensive surgery and RAI ablation can induce remission in the majority of children with Class 2 or 3 PTC but not in patients with distant metastasis. Late recurrence appeared similar in all groups. Table

Table 1 No caption available.

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