EPIDEMIOLOGY AND THERAPY OF THYROID-CANCER IN CHILDHOOD AND ADOLESCENCE

Thyroid cancer is a ran disease in childhood and adolescence. However, it represents the most frequent cancer type in this age group. Thyroi d cancer amounts about 0.5%-1.5% of all malignancies in children and a dolescents. In Germany 10-30 cases could be expected in a year. The mo st common histologic type for this age group is the differentiated thy roid cancer (DTC), i.e. the papillary and follicular subtypes (90%). I n 10% of patients medullary thyroid cancer (MTC) will be diagnosed. DT C occur more often in girls than in boys (female/male-ratio 2:1), with a median age of about 12-13 years (yrs). An important aetiological fa ctor of DTC is a former exposition to different kinds of radiation. In childhood and adolescence MTC mostly appears in patients suffering fr om the syndrom MEN-2, whereas the sporadic form is rare. As in DTC, mo re girls than boys can be diagnosed for MTC (female/male-ratio 2-3:1), with a median age about 10 yrs. The anaplastic/undifferentiated subty pe occurs extremely rare. For all types of thyroid cancer the most imp ortant therapeutic approach is the surgical intervention. In most case s of DTC an optimal disease control could be achieved by radioiodine t herapy, Prognosis of DTC in children and adolescents is favourable. Ho wever therapeutic strategies and modalities reported in the literature are very different. In contrast, prognosis of MTC is rather poor, tha t of the anaplastic type is infaust. No other effective therapy option than surgery is available. To evaluate the therapeutic efficacy of a combined modality therapy by both radiotherapy and cytostatic drugs in children and adolescents with poor prognosis types of thyroid cancer, an interdisciplinary multicenter therapy study will now be started in Germany.