Acharya Suchitra, Sarafoglou Kyriakie, LaQuaglia Michael, Lindsley Skyler, Gerald William, Wollner Norma, Tan Charlotte, Sklar Charles
Department of Pediatrics, New York Presbyterian Hospital and Cornell-Weil Medical School, New York, New York, USA.
Cancer. 2003 May 15;97(10):2397-403. doi: 10.1002/cncr.11362.
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.
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.
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.
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.
近期数据表明，儿童期接受高剂量治疗性放射治疗后，发生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发生的甲状腺病变的时间进程、自然史和组织病理学，作者对纪念斯隆-凯特琳癌症中心接受治疗的所有儿童和青少年恶性肿瘤幸存者进行了一项回顾性研究，这些幸存者出现了临床上明显的甲状腺肿瘤。
作者在儿科数据库、医院肿瘤登记处和医院病历数据库中搜索甲状腺肿瘤患者。
确定了33例在接受放射治疗后发生甲状腺肿瘤的患者。原发诊断为霍奇金病（18例）、非霍奇金淋巴瘤（10例）、急性淋巴细胞白血病（2例）、急性髓细胞白血病（1例）、肾母细胞瘤（1例）和神经母细胞瘤（1例）。原发恶性肿瘤诊断时的中位年龄为12.0岁（范围3.7 - 18.3岁），甲状腺接受的中位放射剂量为2400厘戈瑞（cGy；范围1000 - 4200 cGy），从放射治疗到发现甲状腺疾病的中位间隔时间为13.0年（范围6.2 - 30.1年）。33例甲状腺病变中有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、性别比例以及初始治疗后的时间间隔无差异，但与良性疾病患者相比，恶性疾病患者甲状腺接受的中位放射剂量较低（2000 cGy对2950 cGy；P = 0.03）。所有甲状腺恶性病变患者的疾病均局限于颈部；中位随访6.5年（范围0.9 - 12年）后，无患者出现疾病进展或复发。
本研究数据表明，儿童恶性肿瘤接受放射治疗后出现的临床上明显的甲状腺肿瘤中，很大一部分是恶性的。然而，这些甲状腺恶性肿瘤大多似乎没有侵袭性表现。由于甲状腺肿瘤在放射治疗后数十年可能才会显现，所有有风险的个体都需要终身随访。
