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 present study, children with pulmonary metastases, was designed to clarify this issue. Methods. Fourteen children and young adolescents (mean age, 13.5 years; range, 9.8-17 years) with PTC and pulmonary metastases were treated at our institution between 1937 and 1998. Surgical treatment consisted of total thyroidectomy (n = 10 patients), subtotal thyroidectomy (n = 3 patients), and a biopsy only procedure (n = 1 patient). All patients who underwent thyroidectomy also underwent a variety of cervical lymph node dissections, and all patients proved to have regional nodal disease. After the operation, 12 patients were treated with ablative doses of 131I, 1 patient was treated with external beam irradiation, and all patients were placed on suppressive thyroid 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 patient experienced the development of worsening pulmonary disease or extra-pulmonary metastases. All patients with recurrent disease underwent selective nodal resections. No patient died of metastatic PTC. Seven patients (50%) remain completely free of disease and are probably cured; 7 patients (50%) are asymptomatic with residual pulmonary disease. Conclusions. A stepwise treatment approach allows long-term survival and frequent cure for young patients with PTC and concomitant pulmonary metastases. (Surgery 2000;128:881-7.)
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*Supported in part by funds from the Endocrine Neoplasia Program of the Mayo Foundation, and by National Institutes of Health grant no. CA80117.
**Reprint requests: Jon A. van Heerden, MD, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester MN 55905.
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.