Risk of thyroid cancer in survivors of childhood cancer: Results from the British Childhood Cancer Survivor Study

Taylor, Aliki; Croft, Adam P.; Palace, Aimee M.; Winter, D.; Reulen, Raoul C.; Stiller, Charles; Stevens, Michaël C.G.; Hawkins, Mike

doi:10.1002/ijc.24581

Cited by 100 publications

(73 citation statements)

References 23 publications

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“…This subtype is the most frequent one, not only in the general population, but also following treatment for childhood malignancy. 11,13,37,38,40,41 Some authors found that being less than 10 years of age was associated with an increased risk of thyroid cancer, 11,13,38 although we did not find similar results. In contrast, we confirmed that women are at an increased risk of developing thyroid cancer (HR=4.74; P=0.002), which has been suggested by other studies 13 and observed in the general population.…”

Section: Discussioncontrasting

confidence: 96%

“…36 Many previous studies have focused on thyroid cancer after treatment for childhood cancer. 13,30,[37][38][39] The reported prevalences varied, which may be due to several factors, e.g., the studies were frequently retrospective, based on questionnaires, or included small numbers of patients. In contrast, our study was prospective and included a large number of patients.…”

Section: Discussionmentioning

confidence: 99%

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Late thyroid complications in survivors of childhood acute leukemia. An L.E.A. study

Oudin¹,

Auquier²,

Bertrand³

et al. 2016

Haematologica

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T hyroid complications are known side effects of irradiation. However, the risk of such complications in childhood acute leukemia survivors who received either central nervous system irradiation or hematopoietic stem cell transplantation is less described. We prospectively evaluated the incidence and risk factors for thyroid dysfunction and tumors in survivors of childhood acute myeloid or lymphoid leukemia. A total of 588 patients were evaluated for thyroid function, and 502 individuals were assessed for thyroid tumors (median follow-up duration: 12.6 and 12.5 years, respectively). The cumulative incidence of hypothyroidism was 17.3% (95% CI: 14.1-21.1) and 24.6% (95% CI: 20.4-29.6) at 10 and 20 years from leukemia diagnosis, respectively. Patients who received total body irradiation (with or without prior central nervous system irradiation) were at higher risk of hypothyroidism (adjusted HR: 2.87; P=0.04 and 2.79, P=0.01, respectively) as compared with transplanted patients who never received any irradiation. Patients transplanted without total body irradiation who received central nervous system irradiation were also at higher risk (adjusted HR: 3.39; P=0.02). Patients irradiated or transplanted at older than 10 years of age had a lower risk (adjusted HR: 0.61; P=0.02). Thyroid malignancy was found in 26 patients (5.2%). Among them, two patients had never received any type of irradiation: alkylating agents could also promote thyroid cancer. The cumulative incidence of thyroid malignancy was 9.6% (95% CI: 6.0-15.0) at 20 years. Women were at higher risk than men (adjusted HR: 4.74; P=0.002). In conclusion, thyroid complications are frequent among patients who undergo transplantation after total body irradiation and those who received prior central nervous system irradiation. Close monitoring is thus warranted for these patients.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Late thyroid complications in survivors of childhood acute leukemia. An L.E.A. study

Oudin¹,

Auquier²,

Bertrand³

et al. 2016

Haematologica

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“…Most of the cancers observed are papillary carcinoma and its follicular variants, with no observed systemic metastasis and the probability of developing metastatic disease is small in these patients. Exposure to low-dose ionizing irradiation of the head and neck has been shown to be associated with an increase in the incidence of thyroid nodules and carcinoma during childhood (11,13,16). However, the level of excess risk remains unclear, as not all the population systematically underwent ultrasound screening and some were not screened at all.…”

Section: Discussionmentioning

confidence: 99%

“…The nodules were bilateral in eight (38%) of the 21 patients. Nodule diameter ranged from 6 to 40 mm, with a median value of 13.7 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mm.…”

Section: Ultrasound Findingsmentioning

confidence: 99%

“…The reported relative risks for thyroid nodules among the survivors of pediatric cancers who have undergone radiation therapy vary greatly, with an incidence of malignancy of 10-40% (6,7,8,9,10,11,12,13). Analysis of studies evaluating thyroid carcinoma after exposure to external radiation during childhood showed that the dose-response relationship was linear, although the risk appeared to plateau at the highest dose, with risk appearing to slightly decrease at doses of even more than 2000 cGy (9,11,13,14,15,16). Age at irradiation, sex, and duration of follow-up have also been identified as determinants influencing the risk of thyroid tumors.…”

Section: Introductionmentioning

confidence: 99%

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Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood

Vivanco

Dalle²,

Alberti³

et al. 2012

European Journal of Endocrinology

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Background: The risk of radiation-induced benign and malignant thyroid nodules is well known. Objective: The aim of this study was to determine the occurrence of thyroid nodules and carcinomas after fractionated total body irradiation (TBI) preceding hematopoietic stem cell transplantation (HSCT) for malignant hematological disease during childhood. Methods: We conducted a retrospective university hospital-based observational study. The participants were 76 patients receiving fractionated TBI between 1989 and 2009 as part of the conditioning regimen for HSCT to treat malignant hematological disease, with a median age of 8.2 (5.7-11.4) years, for whom the last ultrasound examination was performed at a median age of 14.2 (11.2-17) years. The main outcome measure was cumulative incidence of thyroid nodules detected by ultrasound scans followed by biopsy if necessary. Results: Thyroid nodules were examined in 21 (28%) patients, six (29%) of whom were diagnosed with thyroid carcinoma at the age of 2.2-18.6 years after TBI. The cumulative incidence of nodule occurrence increased with increasing time from diagnosis. The 10-year cumulative incidence of benign and malignant thyroid nodules was 16% (95% confidence interval (CI) 4-27%) and 8% (95% CI 0-16%) respectively. Seventeen (22%) patients had hypothyroidism (compensated nZ12, in five patients it was transient). No significant independent risk factors were identified in the multivariable competing risk model as a function of nodule occurrence. Conclusion: Short-term and life-long monitoring, with screening for nodules of the thyroid gland using ultrasound scans, is recommended for survivors subjected to TBI for HSCT during childhood.

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Clinical Care for People Who Survive Childhood Cancer

Bhatia,

Tonorezos,

Landier

2023

JAMA

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ImportanceAn estimated 15 000 children and adolescents aged 0 to 19 years are diagnosed with cancer each year in the US, and more than 85% survive for at least 5 years. By 45 years of age, approximately 95% of people who survive childhood cancer will develop a significant health problem related to the childhood cancer diagnosis or its treatment.ObservationsApproximately 500 000 people currently alive in the US have survived childhood cancer. The most common severe or life-threatening chronic health problems related to childhood cancer or its treatment are endocrine disorders such as hypothyroidism or growth hormone deficiency (44%), subsequent neoplasms such as breast cancer or thyroid cancer (7%), and cardiovascular disease such as cardiomyopathy or congestive heart failure, coronary artery disease, and cerebrovascular disease (5.3%). Medical conditions related to a cancer diagnosis during childhood or adolescence are most commonly caused by the radiation therapy and the chemotherapies used to treat cancer and may develop at varying lengths of time after exposure to these treatments. Individuals at highest risk for developing treatment-related health problems include patients with brain cancer treated with cranial irradiation (approximately 70% develop severe or life-threatening health problems) and allogeneic hematopoietic stem cell transplant recipients (approximately 60% develop severe or life-threatening health problems). Individuals at the lowest risk for developing treatment-related health problems include those who survived solid tumors (such as Wilms tumor) treated with surgical resection alone or with minimal chemotherapy, for whom the prevalence of subsequent health problems is similar to people who did not have cancer during childhood or adolescence. People diagnosed with childhood cancer in the 1990s who survived for at least 5 years after the cancer diagnosis have a shorter lifespan (by about 9 years) vs children who were not diagnosed with cancer in the 1990s.Conclusions and RelevanceApproximately 500 000 individuals currently alive in the US have survived childhood cancer. The most common adverse effects in individuals who survived childhood cancer are endocrine disorders, subsequent neoplasms, and cardiovascular disease. There is a need for clinicians and patients to have heightened awareness of these complications.

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Risk of thyroid cancer in survivors of childhood cancer: Results from the British Childhood Cancer Survivor Study

Cited by 100 publications

References 23 publications

Late thyroid complications in survivors of childhood acute leukemia. An L.E.A. study

Late thyroid complications in survivors of childhood acute leukemia. An L.E.A. study

Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood

Clinical Care for People Who Survive Childhood Cancer

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