Demidchik YE et al. (2006) Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg 243: 525–532

The decision whether to perform conservative or radical initial surgery to treat childhood thyroid cancer is a contentious one. Now, a study by Demidchik et al. has found that total thyroidectomy is the best treatment—a change in practice for the team who, up to 1998, favored thyroid-preserving procedures.

The team retrospectively reviewed follow-up data of children treated for thyroid cancer at the Thyroid Cancer Center in Belarus—a part of eastern Europe affected by the 1986 Chernobyl nuclear power station accident. Between 1985 and 2003, 740 children (461 female) were diagnosed with thyroid cancer under the age of 15 years. Over half (426 patients) underwent total thyroidectomy; the rest underwent thyroid-preserving surgery. The authors evaluated the outcome of these different surgical treatments, and determined the risk factors for disease recurrence.

The 10-year, cancer-specific survival rate across the group was 99.2% (overall survival 98.8%). Thyroid cancer recurred in over a quarter of the cohort. The independent risk factors for recurrent nodal disease included young age at diagnosis, node-positive disease, multifocal carcinoma, and absence of neck lymph-node dissection. Lung metastases (seen in almost one-fifth of cases) were strongly associated with a young age at diagnosis, the presence of clinical symptoms (e.g. enlarged neck), and female sex. Radioiodine therapy was highly efficacious: over three-quarters of patients with lung metastases demonstrated a complete response, or a stable partial response, to this treatment. Notably, thyroid-remnant removal was necessary in over a quarter of the patients who initially underwent a thyroid-preserving operation.