Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis?

S C Clement; L C M Kremer; T P Links; R L Mulder; C M Ronckers; B L F van Eck-Smit; R R van Rijn; H J H van der Pal; W J E Tissing; G O Janssens; M M van den Heuvel-Eibrink; S J C M M Neggers; E J M Nieveen van Dijkum; R P Peeters; H M van Santen

doi:10.1016/j.ctrv.2014.10.009

Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis?

Cancer Treat Rev. 2015 Jan;41(1):9-16. doi: 10.1016/j.ctrv.2014.10.009. Epub 2014 Nov 11.

Authors

Affiliations

¹ Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: s.c.clement@amc.uva.nl.
² Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands.
³ Department of Endocrinology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
⁴ Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
⁵ Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
⁶ Department of Radiology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
⁷ Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Oncology, Academic Medical Center, Amsterdam, University of Amsterdam, PO Box 22660 1100 DD Amsterdam, The Netherlands.
⁸ Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
⁹ Department of Radiation Oncology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
¹⁰ Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC/Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
¹¹ Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Internal Medicine/Endocrinology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
¹² Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
¹³ Department of Internal Medicine/Endocrinology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Rotterdam Thyroid Center, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
¹⁴ Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.

PMID: 25544598
DOI: 10.1016/j.ctrv.2014.10.009

Abstract

Background: There is no international consensus on surveillance strategies for differentiated thyroid carcinoma (DTC) after radiotherapy for childhood cancer. Ultrasonography could allow for early detection of DTC, however, its value is yet unclear since the prognosis of DTC is excellent. We addressed the evidence for the question: 'is outcome of DTC influenced by tumor stage at diagnosis?'.

Methods: A multidisciplinary working group answered the sub-questions: 'is recurrence or mortality influenced by DTC stage at diagnosis? Does detection of DTC at an early stage contribute to a decline in adverse events of treatment?' The literature was systematically reviewed, and conclusions were drawn based on the level of evidence (A: high, B: moderate to low, C: very low).

Results: In children, level C evidence was found that detection of DTC at an early stage is associated with lower recurrence and mortality rates. No evidence was found that it influences morbidity rates. In adults, clear evidence was found that less advanced staged DTC is a favorable prognostic factor for recurrence (level B) and mortality (level A). Additionally, it was found that more extensive surgery increases the risk to develop transient hypoparathyroidism (level A) and that higher doses of radioiodine increases the risk to develop second primary malignancies (level B).

Conclusion: Identification of DTC at an early stage is beneficial for children (very low level evidence) and adults (moderate to high level evidence), even considering that the overall outcome is excellent. These results are an important cornerstone for the development of guidelines for childhood cancer survivors at risk for DTC.

Keywords: Childhood Cancer Survivors; Differentiated thyroid carcinoma; External radiotherapy; Radiation damage; Thyroid ultrasonography.

Publication types

Review

MeSH terms

Adult
Child
Early Detection of Cancer
Humans
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Thyroid Neoplasms / diagnosis
Thyroid Neoplasms / pathology*
Thyroid Neoplasms / therapy