Dr. Gary Francis Leads International Task Force to Develop Treatment Guidelines for Children with Thyroid Cancer
As chief of endocrinology and metabolism at Children’s Hospital of Richmond at VCU (CHoR) and a research collaborator with VCU Massey Cancer Center, Gary Francis, MD, PhD, practices both the art and science of caring for children. He is known among his patients and families for his child-friendly, upbeat and inquisitive bedside manner – while his international endocrine peers know him as a thought leader, researcher and educator.
Dr. Francis recently led a task force commissioned by the American Thyroid Association (ATA) to develop a set of guidelines for evaluating and treating children with thyroid nodules and cancer. The newly issued guidelines are the first and only set of recommendations that provide best practice standards for diagnosing and treating thyroid cancer in children ages 18 and younger.
There are many types of thyroid cancer, each beginning in the thyroid gland with the potential to spread to nearby tissue and other parts of the body. Most thyroid cancers are differentiated thyroid cancers (DTC) with the cancer developing from the follicular cells, which use iodine from the blood to make the hormones that help regulate metabolism. DTC and other types are uncommon in children and teens—less than two percent of new cases are in patients under the age of 20—but the chance of being diagnosed has risen over the years, particularly in adolescents.
With every new case, scientists are able to learn more about the pathology and treatment of thyroid nodules and DTC in children. Studies have shown that thyroid tumors in pediatric patients differ from those in adult patients in several ways, from functional changes to long-term outcomes. And while there is a greater risk of malignancy in thyroid cancer diagnosed in children than in adults, children are much less likely to die from the disease.
In most cases, children with DTC have been treated with the same aggressive therapy used on adult patients: the total, surgical removal of the thyroid and treatment with radioactive iodine. The goal of eliminating any evidence of the disease has been considered largely successful until recent long-term follow-up studies revealed that the death rate of childhood DTC survivors has increased due to a second malignancy probably as a result of the radiation used during initial treatment. This evidence prompted the ATA to specifically address the treatment of children with thyroid tumors.
“The course of treatment recommended for an adult may not be appropriate for a child with the same symptoms,” says Francis. “The previous typical treatment for children with thyroid cancer is now associated with an unacceptable risk for complications and risk for second malignancy. New guidelines will provide clinicians and patients the most up-to-date recommendation on how to care for these children.”
The ATA appointed a task force led by Francis and composed of international experts from a variety of disciplines to outline treatment protocols for pediatric patients with thyroid tumors and provide options for acceptable therapy according to the type and stage of the disease. The group first developed questions around the management of children with thyroid tumors and DTC and then reviewed all literature published on patients 18 and younger. Between the opinions of the experts on the committee and the evidence reviewed, the task force developed a set of evidence-based guidelines. Their findings are the first published recommendations for the current optimal care for children with thyroid tumors and DTC.
Because pediatric DTC is so rare and the treatment is continually evolving, future research hinges on the highly organized long-term follow-up of patients. Treatment at research centers like Massey, with multidisciplinary teams working together to provide individualized recommendations for therapy, is the ideal form of care, when possible. As the treatment for DTC improves, Francis hopes that the new guidelines will ensure that the rate of disease-free survival in childhood patients increases with the use of proper and effective therapy.