Background: Pediatric and adolescent thyroid cancer (PATC) incidence rates (IR) are increasing in many countries. We determined IRs, temporal trends and survival from PATC diagnosed in Cyprus during 1998-2017. Procedure: Patients aged 0-19 years, diagnosed with PATC in the Pediatric Oncology Registry of Cyprus were included. Crude IR (cIR), age standardized rates (ASRW), time trends and overall survival were analysed. Annual IRs and temporal trends were calculated using Microsoft Excel 2016 and Joinpoint Regression analysis. Results: Eighty-one cases (76.5% female, 23.5% male) were identified. The cIR (per 100 000 persons) were for both sexes 2.00 (95% CI 1.61, 2.49), females 3.15 (95% CI 2.45, 4.03) and males 0.92 (95% CI 0.58, 1.44). The annual percentage changes (APC) for cIR and ASRW were 7.5% (p < 0.05) and 7.6% (p < 0.05). The APC of cIR were for females 5.1%, males 8.4% and 15-19-year-olds 7.6%. The female to male RR (rate ratio) was 3.42 (95% CI 2.06, 5.74). The papillary carcinoma (PTC) represented 86.4% of all cases. The RR of 2nd (2008-2017) to 1st (1998-2007) periods for metastatic (regional) stages was 3.76 (95% CI 1.74, 8.31). Survival until 2018 was 100%. Conclusion: This population-based study demonstrated that IR in 0-19-year-olds was among the highest reported. Increasing time trends mainly affected both males and females aged 15-19 years with PTC, the dominant type. Increase of metastatic cases suggests a true increase of thyroid carcinogenesis rather than overdiagnosis. Although prognosis is excellent, rising IR is unexplained, indicating the need to identify causal factors.

Background The prognosis of children with acute lymphoblastic leukemia (ALL) has improved considerably over the past decades. However, to achieve cure in patients with refractory disease or relapse new treatment options are mandatory. Methods In the multicenter-trial CoALL-08-09, an additional treatment element consisting of the rarely used chemotherapeutic agent amsacrine combined with etoposide and methylprednisolone (AEP) (amsacrine 2 x 100 mg/m2, etoposide 2 x 500 mg/m2 and methylprednisolone 4 x 1000 mg/m2) was implemented into the first-line treatment of pediatric patients with a poor treatment response at the end of induction (EOI) measured by minimal residual disease (MRD). These patients were stratified into a high-risk intensified arm (HR-I) including an AEP element at the end of consolidation. Patients with induction failure (IF), i.e. lack of cytomorphological remission EOI, were eligible for hematopoietic stem cell transplantation (HSCT) after remission had been reached later on. These patients received AEP as a part of their MRD-guided bridging-to-transplant treatment. Results A significant improvement in probality of overall survival (pOS) for the CoALL-08-09 HR-I patients was noted compared to MRD-matched patients from the preceding CoALL-07-03 trial in the absence of severe or persistent treatment-related toxicities. Relapse rate and probability of event-free survival (pEFS) did not differ significantly between trials. In patients with IF a stable or improved MRD response after AEP was observed without severe or persistent treatment-related toxicities. Conclusion In conclusion, AEP is well-tolerated as a component of the HR treatment and useful in bridging-to-transplant settings.