Department of Radiotherapy, University Hospital of Münster, and Department of Medical Informatics and Biomathematics, University of Münster, Münster, Germany.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e787-91. doi: 10.1016/j.ijrobp.2010.10.037. Epub 2010 Dec 16.
The "Registry for the Evaluation of Side Effects After Radiotherapy in Childhood and Adolescence" (RiSK) has been established to prospectively characterize dose-volume effects of radiation in terms of side effects. The aim of this analysis was to characterize the function of the thyroid gland after radiotherapy to the head-and-neck region in children and adolescents.
Detailed information regarding radiation doses to at-risk organs has been collected across Germany since 2001. Thyroid function was evaluated by blood value examinations of thyroid-stimulating hormone, triiodothyronine, and thyroxine. Information regarding thyroid hormone substitution was requested from the treating physicians.
Until May 2009, 1,086 patients from 62 centers were recruited, including 404 patients (median age, 10.9 years) who had received radiotherapy to the thyroid gland and/or hypophysis. Follow-up information was available for 264 patients (60.9%; median follow-up, 40 months), with 60 patients (22.7%) showing pathologic values. In comparison to patients treated with prophylactic cranial irradiation (median dose, 12 Gy), patients with radiation doses of 15 to 25 Gy to the thyroid gland had a hazard ratio of 3.072 (p=0.002) for the development of pathologic thyroid blood values. Patients with greater than 25 Gy to the thyroid gland and patients who underwent craniospinal irradiation had hazard ratios of 3.768 (p=0.009) and 5.674 (p<0.001), respectively. The cumulative incidence of thyroid hormone substitution therapy did not differ between defined subgroups.
Radiation-induced thyroid function impairment, including damage to the thyroid gland and/or hypophysis, can frequently be observed after radiotherapy in children. A structured follow-up examination is advised.
“儿童和青少年放疗后副作用评估登记（RiSK）”已建立，旨在前瞻性地描述放射治疗的剂量-体积效应与副作用之间的关系。本分析的目的是描述儿童和青少年头颈部放疗后甲状腺功能的变化。
自 2001 年以来，德国各地详细收集了有关危险器官受辐射剂量的信息。通过甲状腺刺激激素、三碘甲状腺原氨酸和甲状腺素的血液值检查来评估甲状腺功能。还向治疗医生询问了甲状腺激素替代的信息。
截至 2009 年 5 月，共招募了来自 62 个中心的 1086 名患者，其中 404 名患者（中位年龄 10.9 岁）接受了甲状腺和/或垂体放疗。有 264 名患者（60.9%）可获得随访信息，其中 60 名患者（22.7%）出现了病理值。与接受预防性颅脑照射（中位剂量 12Gy）的患者相比，甲状腺接受 15-25Gy 照射的患者出现病理甲状腺血值的风险比为 3.072（p=0.002）。甲状腺接受超过 25Gy 照射和接受颅脊髓照射的患者的风险比分别为 3.768（p=0.009）和 5.674（p<0.001）。未发现定义的亚组之间甲状腺激素替代治疗的累积发生率存在差异。
儿童接受放疗后常可观察到放射性甲状腺功能损伤，包括甲状腺和/或垂体损伤。建议进行结构化的随访检查。
