TY - JOUR
T1 - Thyroid Radiation Dose and Other Risk Factors of Thyroid Carcinoma Following Childhood Cancer
AU - de Vathaire, Florent
AU - Haddy, Nadia
AU - Allodji, Rodrigue S
AU - Hawkins, Michael
AU - Guibout, Catherine
AU - El-Fayech, Chiraz
AU - Teinturier, Cécile
AU - Oberlin, Odile
AU - Pacquement, Hélène
AU - Diop, Fara
AU - Kalhouche, Amar
AU - Benadjaoud, Mohamedamine
AU - Winter, David
AU - Jackson, Angela
AU - Bezin Mai-Quynh, Giao
AU - Benabdennebi, Aymen
AU - Llanas, Damien
AU - Veres, Cristina
AU - Munzer, Martine
AU - Nguyen, Tan Dat
AU - Bondiau, Pierre-Yves
AU - Berchery, Delphine
AU - Laprie, Anne
AU - Deutsch, Eric
AU - Lefkopoulos, Dimitri
AU - Schlumberger, Martin
AU - Diallo, Ibrahima
AU - Rubino, Carole
PY - 2015/11
Y1 - 2015/11
N2 - 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.
AB - 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.
U2 - 10.1210/jc.2015-1690
DO - 10.1210/jc.2015-1690
M3 - Article
C2 - 26327481
SN - 0021-972X
VL - 100
SP - 4282
EP - 4290
JO - The Journal of clinical endocrinology and metabolism
JF - The Journal of clinical endocrinology and metabolism
IS - 11
ER -
