Thyroid Radiation Dose and Other Risk Factors of Thyroid Carcinoma Following Childhood Cancer

Florent de Vathaire, Nadia Haddy, Rodrigue S Allodji, Michael Hawkins, Catherine Guibout, Chiraz El-Fayech, Cécile Teinturier, Odile Oberlin, Hélène Pacquement, Fara Diop, Amar Kalhouche, Mohamedamine Benadjaoud, David Winter, Angela Jackson, Giao Bezin Mai-Quynh, Aymen Benabdennebi, Damien Llanas, Cristina Veres, Martine Munzer, Tan Dat NguyenPierre-Yves Bondiau, Delphine Berchery, Anne Laprie, Eric Deutsch, Dimitri Lefkopoulos, Martin Schlumberger, Ibrahima Diallo, Carole Rubino

    Research output: Contribution to journalArticlepeer-review

    22 Citations (Scopus)

    Abstract

    CONTEXT: Thyroid carcinoma is a frequent complication of childhood cancer radiotherapy. The dose response to thyroid radiation dose is now well established, but the potential modifier effect of other factors requires additional investigation.

    OBJECTIVE: This study aimed to investigate the role of potential modifiers of the dose response.

    DESIGN: We followed a cohort of 4338 5-year survivors of solid childhood cancer treated before 1986 over an average of 27 years. The dose received by the thyroid gland and some other anatomical sites during radiotherapy was estimated after reconstruction of the actual conditions in which irradiation was delivered.

    RESULTS: Fifty-five patients developed thyroid carcinoma. The risk of thyroid carcinoma increased with a radiation dose to the thyroid of up to two tenths of Gy, then leveled off for higher doses. When taking into account the thyroid radiation dose, a surgical or radiological splenectomy (>20 Gy to the spleen) increased thyroid cancer risk (relative risk [RR] = 2.3; 95% confidence interval [CI], 1.3-4.0), high radiation doses (>5 Gy) to pituitary gland lowered this risk (RR = 0.2; 95% CI, 0.1-0.6). Patients who received nitrosourea chemotherapy had a 6.6-fold (95% CI, 2.5-15.7) higher risk than those who did not. The excess RR per Gy of radiation to the thyroid was 4.7 (95% CI, 1.7-22.6). It was 7.6 (95% CI, 1.6-33.3) if body mass index at time of interview was equal or higher than 25 kg/m(2), and 4.1 (95% CI, 0.9-17.7) if not (P for interaction = .1).

    CONCLUSION: Predicting thyroid cancer risk following childhood cancer radiation therapy probably requires the assessment of more than just the radiation dose to the thyroid. Chemotherapy, splenectomy, radiation dose to pituitary gland, and obesity also play a role.

    Original languageEnglish
    Pages (from-to)4282-90
    Number of pages9
    JournalThe Journal of clinical endocrinology and metabolism
    Volume100
    Issue number11
    Early online date1 Sep 2015
    DOIs
    Publication statusPublished - Nov 2015

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