Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation.
Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation.
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DOI：
10.1007/s11764-016-0588-6
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发表时间：
2017-06
期刊：
影响因子：
--
通讯作者：
Oeffinger KC
中科院分区：
文献类型：
--
作者：
Tonorezos ES;Barnea D;Moskowitz CS;Chou JF;Sklar CA;Elkin EB;Wong RJ;Li D;Tuttle RM;Korenstein D;Wolden SL;Oeffinger KC
在儿童和年轻成人癌症暴露于颈部辐射的幸存者中筛查甲状腺癌的最佳方法仍然存在争议。缺乏基于体检的筛查方法的结果数据。我们对2005年11月至2014年8月期间在纪念斯隆-凯特琳成人长期随访诊所接受颈部放射治疗的儿童和青年癌症成年幸存者进行了回顾性分析。符合条件的患者接受甲状腺体格检查，并随访至少一年。不合格患者为既往诊断为良性或恶性甲状腺结节的患者。在中位随访3.1年（范围0-9.4年）期间，对585名患者进行了106次超声检查和2，277次体格检查。40名幸存者在放疗后21年内甲状腺体检异常; 50%的体检异常者是霍奇金淋巴瘤幸存者，60%的人在10-19岁时接受过放疗，53%的人是女性。最终，24例接受了细针穿刺（FNA）。手术发现乳头状癌7名幸存者，6名目前没有疾病，一名活动性疾病正在观察等待。在每年接受一次或多次体检的患者中，代表1，732人年的随访，在正常体检的一年内没有诊断出甲状腺癌病例。这些发现支持在没有常规超声的情况下进行年度体检的应用甲状腺癌筛查有颈部放射史的幸存者。有颈部放射史的幸存者可能不需要常规甲状腺超声进行甲状腺癌筛查。
The optimal method of screening for thyroid cancer in survivors of childhood and young adult cancer exposed to neck radiation remains controversial. Outcome data for a physical exam-based screening approach are lacking. We conducted a retrospective review of adult survivors of childhood and young adult cancer with a history of neck radiation followed in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering between November 2005 and August 2014. Eligible patients underwent physical exam of the thyroid and were followed for at least one year afterwards. Ineligible patients were those with prior diagnosis of benign or malignant thyroid nodules. During a median follow-up of 3.1 years (range 0–9.4 years), 106 ultrasounds and 2,277 physical exams were performed among 585 patients. Forty survivors had an abnormal thyroid physical exam a median of 21 years from radiotherapy; fifty percent of those with an abnormal exam were survivors of Hodgkin lymphoma, 60% had radiation at ages 10–19 and 53% were female. Ultimately, 24 underwent fine needle aspiration (FNA). Surgery revealed papillary carcinoma in 7 survivors; 6 are currently free of disease and one with active disease is undergoing watchful waiting. Among those with one or more annual visits, representing 1,732 person-years of follow-up, no cases of thyroid cancer were diagnosed within a year of normal physical exam. These findings support the application of annual physical exam without routine ultrasound for thyroid cancer screening among survivors with a history of neck radiation. Survivors with a history of neck radiation may not require routine thyroid ultrasound for thyroid cancer screening.
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6.2
作者：
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