vrijdag 11 maart 2016

Hoe de zorg beter kan bij kinderen met schildklierkanker

De overleving van kinderen met gedifferentieerde schildklierkanker (DTC) is uitstekend. Daarom heeft het minimaliseren van complicaties (o.a. hypoparathyreoïdie) belangrijke prioriteit. Deze studie toont een veelvuldig voorkomen van zulke levenslange postoperatieve complicaties. Nadelige effecten kunnen worden verminderd door de centralisatie van de zorg en therapie op maat, wat cruciaal is voor kinderen met DTC.

Pediatric differentiated thyroid carcinoma in the Netherlands: a nationwide follow-up study
Mariëlle S. Klein Hesselink, Marloes Nies, Gianni Bocca, Adrienne H. Brouwers, Johannes G.M. Burgerhof, Eveline W.C.M. van Dam, Bas Havekes, Marry M. van den Heuvel-Eibrink, Eleonora P.M. Corssmit, Leontien C.M. Kremer, Romana T. Netea-Maier, Heleen J.H. van der Pal, Robin P. Peeters, Kurt W. Schmid, Johannes W.A. Smit, Graham R. Williams, John T.M. Plukker, Cécile M. Ronckers, Hanneke M. van Santen, Wim J.E. Tissing, Thera P. Links

Differentiated thyroid carcinoma in children: Late effects of treatment and pathophysiological background in the Netherlands
Nederlands Trial Register

Deze ‘early release’ tekst kan in dit voor-publicatie-stadium nog gewijzigd worden.

Introduction

Treatment for differentiated thyroid carcinoma (DTC) in pediatric patients is based mainly on evidence from adult series due to lack of data from pediatric cohorts. Our objective was to evaluate presentation, treatment-related complications, and long-term outcome in patients with pediatric DTC in the Netherlands.

Patients and methods

In this nationwide study, presentation, complications and outcome of patients with pediatric DTC (age at diagnosis younger than 18 years) treated in the Netherlands between 1970 and 2013 were assessed using medical records.

Results

We identified 170 patients. Overall survival was 99.4% after median follow-up of 13.5 (range 0.3–44.7) years. Extensive follow-up data were available for 105 patients (83.8% women), treated in 39 hospitals. Median age at diagnosis was 15.6 (range 5.8–18.9) years. At initial diagnosis, 43.8% of the patients had cervical lymph node metastases; 13.3% had distant metastases. All patients underwent total thyroidectomy. Radioiodine was administered to 97.1%, with a median cumulative activity of 5.66 (range 0.74–35.15) GBq.

Lifelong postoperative complications (permanent hypoparathyroidism and/or recurrent laryngeal nerve injury) were present in 32.4% of the patients. At last known follow-up, 8.6% of the patients had persistent disease and 7.6% experienced a recurrence. TSH suppression was not associated with recurrences.

Conclusions

Survival of pediatric DTC is excellent. Therefore, minimizing treatment-related morbidity takes major priority. Our study shows a frequent occurrence of lifelong postoperative complications. Adverse effects may be reduced by centralization of care, which is crucial for children with DTC.



Geen opmerkingen:

Een reactie plaatsen

Let op!

Raadpleeg altijd een arts als je twijfelt over je gezondheid. De informatie op dit blog kan niet worden beschouwd als vervanging van een consult of een behandeling.