Papillary thyroid cancer with pulmonary metastases in children: Long-term prognosis

Background. Papillary thyroid cancer (PTC) in young patients may rarely be encountered with pulmonary metastases. Previous studies have suggested that , in the pediatric population, this may not portend a lethal outcome. Our p resent study, children with pulmonary metastases, was designed to clarify t his issue. Methods. Fourteen children and young adolescents (mean age, 13.5 years; ran ge, 9.8-17 years) with PTC and pulmonary metastases were treated at our ins titution between 1937 and 1998. Surgical treat ment consisted of total thyr oidectomy (n = 10 patients), subtotal thyroidectomy (n = 3 patients), and a biopsy only procedure (n = 1 patient). All patients who underwent thyroide ctomy also underwent a variety of cervical lymph node dissections, and all patients proved to have regional nodal disease. After the operation, 12 pat ients were treated with ablative doses of I-131, 1 patient was created with external beam irradiation, and all patients were placed on suppressive thy roid hormone therapy. The mean length of follow-up was 19.3 years (range, 1 -45 years). Results. Regional recurrent disease developed in 2 patients (15%). No patie nt experienced the development of worsening pulmonary disease or extra-pulm onary metastases. All patients with recurrent disease underwent selective n odal resections. No patient died of metastatic PTC. Seven patients (50%) re main completely free of disease and are probably cured; 7 patients (50%) ar e asymptomatic with residual pulmonary disease. Conclusions. A stepwise treatment approach allows long-term survival and fr equent cure for young patients with PTC and concomitant;pulmonary metastase s.