The Impact of Radioactive Iodine on Outcomes Among Pediatric and Adolescent Thyroid Cancer Patients: A SEER Database Analysis
by
, , , , and
Emily M. Persons
1, 
Mohammad H. Hussein
2,
Marcela Herrera
1,
Dylan Pinion
3,
Alyssa Webster
4,
Eric Pineda
1,
Manal S. Fawzy
5
,
Eman A. Toraih
6,7,*
and
Emad Kandil
6 1
School of Medicine, Tulane University, New Orleans, LA 70112, USA
2
Ochsner Clinic Foundation, New Orleans, LA 70112, USA
3
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
4
Department of Surgery, UMass Chan Medical School-Baystate, Springfield, MA 01107, USA
5
Center for Health Research, Northern Border University, Arar 91431, Saudi Arabia
6
Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
7
Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(1), 107; https://doi.org/10.3390/cancers17010107
Submission received: 3 December 2024
/
Revised: 28 December 2024
/
Accepted: 29 December 2024
/
Published: 1 January 2025
(This article belongs to the Section Pediatric Oncology)
Simple Summary
The use of radioactive iodine (RAI) ablation is a common therapy among adults with differentiated thyroid cancer. However, the clinical outcomes and long-term effects of this treatment in pediatric thyroid cancer patients remain uncertain. The aim of our retrospective cohort study was to assess the risks and survival benefits of RAI in pediatric thyroid cancer patients. Using data from patients aged 21 years or younger with differentiated thyroid cancer from the SEER cancer registries, we confirmed RAI did not show any significant impact on recurrence, second malignancy, or mortality. There was no significant difference in long-term survival between pediatric patients who received RAI and those who did not. Thus, excellent clinical outcomes are achieved regardless of RAI use in differentiated pediatric thyroid cancer.
Abstract
Background/Objectives: Pediatric populations with well-differentiated thyroid cancer typically have favorable prognoses. However, the role of radioactive iodine (RAI) ablation in these patients remains uncertain. This investigation evaluates the national trends, therapeutic practices, and the impact of RAI on clinical outcomes. Methods: Patients aged 21 years or younger with differentiated thyroid cancer, identified from the SEER database between 2000 and 2019, were analyzed. We compared the treatment approaches and survival outcomes of patients who underwent RAI ablation with those who did not. Results: This retrospective cohort study encompassed 5318 pediatric patients, with 55.9% (n = 2973) who underwent RAI ablation. RAI utilization declined from 65% to 38.4% in 2019. Compared with those who did not undergo RAI, RAI patients presented with a larger tumor size (mean size: 27.7 vs. 20.4 mm), a higher T3/T4 stage (35.8% vs. 15.3%), nodal metastases (60.7% vs. 28.8%), and distant metastases (2.7% vs. 0.9%) (all p < 0.001). Despite this, RAI was not an independent predictor of recurrence, second malignancy, or mortality. The analysis showed no significant differences in long-term survival between the RAI and non-RAI groups (p > 0.05), with African American patients having an increased risk of mortality (HR = 3.81; p = 0.038). Cancer-directed surgery emerged as a protective factor (HR = 0.08; p = 0.018), while RAI treatment did not significantly affect mortality risk (p = 0.09). Conclusions: Excellent pediatric thyroid cancer outcomes were achieved regardless of RAI use. Further research should clarify appropriate RAI indications while addressing racial outcome inequities.
