Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence
Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence
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DOI：
10.1002/cncr.11362
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发表时间：
2003-05-15
期刊：
影响因子：
6.2
通讯作者：
Sklar, C
中科院分区：
文献类型：
--
作者：
Acharya, S;Sarafoglou, K;Sklar, C
背景最近的数据表明，在儿童时期接受高剂量治疗性放射治疗后，患甲状腺肿瘤的风险明显增加。为了更好地了解高剂量照射后甲状腺病变的时间进程、自然史和组织病理学，作者对在纪念斯隆-凯特琳癌症中心接受治疗并发展为临床明显甲状腺肿瘤的所有儿童和青少年恶性肿瘤幸存者进行了回顾性研究。作者检索了儿科数据库、医院肿瘤登记处和医院病历数据库中的甲状腺肿瘤患者。确定了33名患者在治疗性放射治疗后发生甲状腺肿瘤。初步诊断为霍奇金病（n = 18例患者）、非霍奇金淋巴瘤（n = 10例患者）、急性淋巴细胞白血病（n = 2例患者）、急性髓性白血病（n = 1例患者）、肾母细胞瘤（n = 1例患者）和神经母细胞瘤（n = 1例患者）。诊断原发性恶性肿瘤时的中位年龄为12.0岁（范围，3.7 - 18.3年），甲状腺的中位辐射剂量为2400 cGy（cGy;范围，1000 - 4200 cGy），从放射治疗到识别甲状腺疾病的中位间隔为13.0年（范围，6.2 - 30.1年）。33例甲状腺病变中13例（39%）为恶性（11例乳头状癌和2例滤泡状癌）。恶性和良性病变患者的诊断年龄、性别比和初始治疗后的时间无差异，但恶性疾病患者的甲状腺中位辐射剂量低于良性疾病患者（2000 cGy vs. 2950 cGy; P = 0.03）。在所有患有恶性甲状腺病变的患者中，疾病局限于颈部;在中位随访6.5年（范围，0.9 - 12年）后，没有患者发生疾病进展或复发。这项研究的数据表明，在儿童恶性肿瘤治疗性放疗后发生的临床明显甲状腺肿瘤中，恶性肿瘤的比例很高。然而，这些甲状腺恶性肿瘤中的大多数似乎没有表现出侵略性。由于甲状腺肿瘤在放射治疗后几十年内可能不会变得明显，因此所有有风险的人都需要终身随访。(C)2003年美国癌症协会。
BACKGROUND. Recent data indicate that the risk of developing a thyroid neoplasm clearly is increased after high-dose, therapeutic radiation therapy during childhood. To better understand the time course, natural history, and histopathology of thyroid lesions that develop after high-dose irradiation, the authors undertook a retrospective study of all survivors of childhood and adolescent malignancies who were treated at Memorial Sloan-Kettering Cancer Center and who developed a clinically apparent thyroid neoplasm.METHODS. The authors searched the data base of the Department of Pediatrics, the hospital-based tumor registry, and the hospital medical records database for patients with thyroid neoplasms.RESULTS. Thirty-three patients were identified who developed a thyroid neoplasm after therapeutic radiation. Primary diagnoses were Hodgkin disease (n = 18 patients), non-Hodgkin lymphoma (n = 10 patients), acute lymphoblastic leukemia (n = 2 patients), acute myeloid leukemia (n = 1 patient), Wilms tumor (n = 1 patient), and neuroblastoma (n = 1 patient). The median age at the time of diagnosis of the primary malignancy was 12.0 years (range, 3.7-18.3 years), the median radiation dose to the thyroid gland was 2400 centigrays (cGy; range, 1000-4200 cGy), and the median interval from the time of radiation therapy until the recognition of thyroid disease was 13.0 years (range, 6.2-30.1 years). Thirteen of 33 thyroid lesions (39%) were malignant (11 papillary carcinomas and 2 follicular carcinomas). Age at diagnosis, gender ratio, and time elapsed since initial treatment did not differ between patients with malignant and benign lesions, but the median radiation dose to the thyroid was lower in patients who had malignant disease compared with patients who had benign disease (2000 cGy vs. 2950 cGy; P = 0.03). Disease was confined to the neck in all patients who had malignant thyroid lesions; after a median follow-up of 6.5 years (range, 0.9-12 years), none of the patients developed progressive or recurrent disease.CONCLUSIONS. Data from this study suggest that a high proportion of clinically apparent thyroid neoplasms that develop after therapeutic radiation for a childhood malignancy are malignant. However, most of these thyroid malignancies do not appear to behave in an aggressive fashion. Because thyroid neoplasms may not become evident for decades after radiation therapy, all individuals who are at risk require life-long follow-up. (C) 2003 American Cancer Society.