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ABSTRACT Aim: Thyroid cancers are the most commonly determined cancers in the paediatric age group. Although the rates of lymph node and distant metastases are greater at the time of diagnosis in comparison with adult thyroid cancers, with the appropriate treatment protocols, the prognosis is excellent. In this paper, we present the clinical characteristics of thyroid papillary carcinoma determined in children and adolescents in our clinic, the surgical techniques applied and the clinical results evaluated in consideration of the relevant literature. Methods: A retrospective evaluation of 12 patient records in the paediatric and adolescent age group from a total of 250 who underwent surgery for a diagnosis of thyroid papillary carcinoma at Ankara Oncology Training and Research Hospital between 2000 and 2007. Results: The prevalence of thyroid and papillary carcinoma in childhood and adolescence was determined as 4.8%. The patients were all female with a mean age of 17.9 years (range, 11-21 years). At the time of diagnosis, lymph node metastases were identified in seven cases (58.3%) and lung metastases in four cases (33.3%). Total thyroidectomy was performed on all patients and for those with lymph node metastasis; a modified radical neck dissection was also applied. Post-operatively, all patients were administered radioactive iodine therapy followed by levothyroxine therapy. During the mean follow-up period of 123 months, apart from persistent tumour in some patients, no recurrence was noted in other patients. Conclusion: As thyroid papillary carcinoma in childhood and adolescence is characterized by lymph node and distant metastases, even if the tumour is limited to the thyroid, because of frequent recurrence after treatment, total thyroidectomy and, where necessary, modified neck dissection are recommended for all patients rather than more conservative treatment protocols.
ABSTRACT
Background: Bone is the most common metastatic site for breast cancer. Aim: To determine the effectiveness of addition of chemotherapy to hormonal therapy in postmenopausal hormone receptor-positive breast cancer patients with isolated bone metastases. Materials and Methods: Between June 2001 and January 2007, 101 patients were classified into two groups according to initial treatment modalities; patients who received hormonotherapy only (group I) and chemotherapy followed by hormonotherapy (group II). The effect of treatment choice on clinical course, time to progression, and overall survival were evaluated. Results: There were 70 patients in group I and 31 patients in group II. Bone metastases in 27 patients (26.7%) were synchronous and the remainder were metachronous. The median follow-up time was 41 months. The two groups showed similar results when patients' tumor characteristics were compared. However, 81% of synchronous cases had upfront chemotherapy following hormonotherapy, whereas this ratio was only 12% in the metachronous group. All patients received systemic antiresorptive bisphosphonates whereas only 24 patients required palliative radiotherapy at some time during the course of their disease. In groups I and II, the median time to progression was 12 and 16 months (P: 0.96) and median overall survival was 41 and 40 months (P: 0.79), respectively. In HER-2-positive patients, a trend of prolongation of overall survival was observed in group II, but it was not statistically significant (P: 0.12). Conclusions: Anti-hormonal therapy still seems to be considered as the ideal treatment of choice for postmenapousal breast cancer patients with isolated bone metastases.