Pediatric Differentiated Thyroid Carcinoma in The Netherlands: A Nationwide Follow-Up Study

Introduction: Treatment for differentiated thyroid carcinoma (DTC) in pediatric patients is based mainly on evidence from adult series due to lack of data from pediatric cohorts. Our objective was to evaluate presentation, treatment-related complications, and long-term outcome in patients with pediatric DTC in the Netherlands. Patients and methods: In this nationwide study, presentation, complications and outcome of patients with pediatric DTC (age at diagnosis ≤18 years) treated in the Netherlands between 1970 and 2013 were assessed using medical records. Results: We identified 170 patients. Overall survival was 99.4% after median follow-up of 13.5 (range 0.3–44.7) years. Extensive follow-up data were available for 105 patients (83.8% women), treated in 39 hospitals. Median age at diagnosis was 15.6 (range 5.8–18.9) years. At initial diagnosis, 43.8% of the patients had cervical lymph node metastases; 13.3% had distant metastases. All patients underwent total thyroidectomy. Radioiodine was administered to 97.1%, with a median cumulative activity of 5.66 (range 0.74–35.15) GBq. Lifelong postoperative complications (permanent hypoparathyroidism and/or recurrent laryngeal nerve injury) were present in 32.4% of the patients. At last known follow-up, 8.6% of the patients had persistent disease and 7.6% experienced a recurrence. TSH suppression was not associated with recurrences (OR 2.00, 95% CI 0.78 to 5.17, P = 0.152). Conclusions: Survival of pediatric DTC is excellent. Therefore, minimizing treatment-related morbidity takes major priority. Our study shows a frequent occurrence of lifelong postoperative complications. Adverse effects may be reduced by centralization of care, which is crucial for children with DTC

Nutritional status, body composition and chemotherapy dosing in children and young people with cancer: a systematic review by the SIOP nutrition network

\ua9 The Author(s) 2025.Abstract: Malnutrition (undernutrition or overweight/obesity) might significantly impact the pharmacokinetics and pharmacodynamics of antineoplastic drugs in children and adolescents (<21 years). A comprehensive systematic literature search was performed on MEDLINE (PubMed), EMBASE, Web of Science, Scopus, ProQuest, Cochrane Trials, and Cochrane Reviews. Databases were searched up to 30 September 2024. Of 4186 articles identified, 150 full texts were evaluated and 12 selected for inclusion. Eight additional articles were identified following a panel review and 6 included, resulting in a total of 18 articles for data extraction. Relevant pharmacokinetic parameters were described for mercaptopurine, vincristine, anthracyclines, methotrexate, busulfan, bevacizumab, and crizotinib. Due to the heterogeneity and limited number of studies per antineoplastic drug, formal statistical analysis or meta-analysis was not appropriate. Variations in the definition of nutritional status, dosing strategies, and type of pharmacokinetic analyses were observed; therefore, no dosing recommendations could be made. With the increasing childhood cancer burden in LMIC, high prevalence of undernutrition, and the global burden of childhood obesity, there is an urgent need for more research in this area. Prospective studies should incorporate uniform definitions and standardised pharmacological approaches to optimise treatment options for children with cancer globally. Systematic literature review registration: PROSPERO: (reference: CRD42023435261

BMI trajectories in the first 3 months after childhood craniopharyngioma resection: a plea for early management of BMI changes

OBJECTIVE: Hypothalamic obesity (HO) is a severe condition following childhood craniopharyngioma (cCP) treatment. Despite multidisciplinary and centralized care, severe body mass index (BMI) changes are still often encountered after cCP surgery. We aimed to perform an in-depth analysis of BMI trajectories in our cCP cohort in the first year after surgery and to identify characteristics associated with BMI change. METHODS: Data were collected of cCP patients diagnosed since January 2018. Change (Δ) in BMI standard deviation scores (SDSs) from treatment to 3, 6, 9 and 12 months after and latest follow-up was assessed. Secondary outcomes were patient, tumor and treatment characteristics associated with ΔBMI SDS and interventions for postoperative weight gain. RESULTS: Of the 35 cCP patients, the most significant BMI SDS change was observed within the first three months following cCP resection, with almost half of the patients developing an increase of ≥1.0 BMI SDS. Of patients with the most severe BMI change within the first three months, 87% were overweight or obese at 12 months after cCP resection. Pharmacological intervention for obesity started on average 10.8 months postresection. Development of arginine vasopressin deficiency was positively correlated with ΔBMI SDS in the first three months (P = 0.017). Barriers for obesity intervention in the first months following treatment are discussed. CONCLUSIONS: Following cCP resection, increase in BMI due to hypothalamic damage is most severe already in the first three months postoperatively. Postoperative rapid weight gain should be acknowledged as a consequence of hypothalamic damage and requires more early intervention aiming to prevent the development of HO

Measurement properties of instruments to assess pain in children and adolescents with cancer: A systematic review protocol

© 2019 The Author(s). Background: Pain in children and adolescents with cancer has been identified as an area where many healthcare professionals seek guidance. This protocol details a systematic review whose aim is to explore current knowledge regarding measurement instruments to assess pain (and pain-related distress) in children and adolescents with cancer. After completion of the review, the information will be used in the development of a clinical practice guideline. Methods: We will search four electronic databases (MEDLINE via PubMed, CINAHL, PsycINFO and HaPI). Additional relevant studies will be identified by reference checking and expert consultation. All citations will be screened independently by two reviewers in a three-step approach: first selection based on title, second selection based on abstract, third selection based on full-text. Studies in children and adolescents with cancer that aimed to evaluate the clinimetric properties of an existing pain measurement instrument or to develop a new pain measurement instrument and that include at least one relevant outcome (reliability, validity, responsiveness, interpretability, clinical utility) are eligible for inclusion. For all steps of evidence selection, a detailed list with eligibility criteria will be determined a priori. Data extraction and quality assessment of included studies (according to the COnsensus-based Standards for the selection of health Measurement INstruments, COSMIN criteria) will be conducted independently by two authors. Discussion: This systematic review will provide an overview of the current literature regarding measurement instruments to assess pain in children and adolescents with cancer. This knowledge synthesis will be used to formulate recommendations for clinical practice. Also, by synthesizing existing evidence, knowledge gaps will be identified. Systematic review registration: PROSPERO CRD4201707287

Risk and temporal changes of heart failure among 5-year childhood cancer survivors: a DCOG-LATER study

Background Heart failure is one of the most important late effects after treatment for cancer in childhood. The goals of this study were to evaluate the risk of heart failure, temporal changes by treatment periods, and the risk factors for heart failure in childhood cancer survivors (CCS). Methods and Results The DCOG‐LATER (Dutch Childhood Oncology Group–Long‐Term Effects After Childhood Cancer) cohort includes 6,165 5‐year CCS diagnosed between 1963 and 2002. Details on prior cancer diagnosis and treatment were collected for this nationwide cohort. Cause‐specific cumulative incidences and risk factors of heart failure were obtained. Cardiac follow‐up was complete for 5,845 CCS (94.8%). After a median follow‐up of 19.8 years and at a median attained age of 27.3 years, 116 survivors developed symptomatic heart failure. The cumulative incidence of developing heart failure 40 years after childhood cancer diagnosis was 4.4% (3.4%–5.5%) among all CCS. The cumulative incidence of heart failure grade ≥3 among survivors treated in the more recent treatment periods was higher compared with survivors treated earlier (Gray test, P=0.05). Mortality due to heart failure decreased in the more recent treatment periods (Gray test, P=0.02). In multivariable analysis, survivors treated with a higher dose of mitoxantrone or cyclophosphamide had a higher risk of heart failure than survivors who were exposed to lower doses. Conclusions CCS treated with mitoxantrone, cyclophosphamide, anthracyclines, or radiotherapy involving the heart are at a high risk for severe, life‐threatening or fatal heart failure at a young age. Although mortality decreased, the incidence of severe or life‐threatening heart failure increased with more recent treatment periods