Follow Up in a Pediatric Cohort with Differentiated Thyroid Cancer (DTC): Response to Initial Therapy at 2 Years

P PAPENDIECK. .; S MAGLIO; I BERGADA; M VENARA,; E ELIAS; H COZZANI; F MATEOS,; A CHIESA

Cusco

Congreso; XXVI Congreso de la Sociedad Latinoamericana de Endocrinologia Pediatrica; 2018

Sociedad Latinoamericana de Endocrinologia Pediatrica SLEP

Background: DTC in childhood has a more aggressive presentationbut no overall increase in mortality compared to adults. Objective:to describe the initial postoperative ATA risk classificationof a cohort of pediatric patients with DTC treated uniformly andto evaluate the response to initial therapy at 2 years based on themodified ATA dynamic risk stratification (DRS) for adults.Patients and Methods: We retrospectively analyzed a cohortof 17 pediatric patients diagnosed with papillary DTC between2008 and 2015 treated initially with total thyroidectomy and radioactivethyroid ablation. Median age at diagnosis was 13.8 years(range 5.2?18) and 11/17 were pubertal. Initial ATA risk was classifiedin low, intermediate and high risk according to TNM, thyroglobulin(TG) and images. Clinical outcome at 2 years was assessedby DRS into 4 categories: excellent response (non-evidenceof disease [NED]), indeterminate response, biochemical incompleteresponse and structural incomplete response according tostimulated TG and imaging findings.Results: Postoperative ATA risk classification showed 18%,18% and 64% patients with low, intermediate and high risk. DRSat 2 years revealed 47%, 18%, 6% and 29% of patients with excellent,indeterminate, biochemical incomplete and structural incompleteresponse respectively. At 2 years all low risk patients remainedNED while 33% of the intermediate and 36% of the highrisk group achieved NED status.Conclusions: The aggressiveness of pediatric DTC at presentationassessed by the pediatric ATA risk classification was confirmedin our cohort. Dynamic DRS at 2 years of follow-up showeda marked change compared to admission. Although preliminary,our results suggest that DRS is a good and useful response to therapycategorization for the surveillance of pediatric DTC patients.Its use would allow a more accurate treatment decision accordingto changes in biochemical and structural findings.