Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
J Cancer Surviv. 2017 Jun;11(3):302-308. doi: 10.1007/s11764-016-0588-6. Epub 2016 Dec 27.
The optimal method of screening for thyroid cancer in survivors of childhood and young adult cancer exposed to neck radiation remains controversial. Outcome data for a physical exam-based screening approach are lacking.
We conducted a retrospective review of adult survivors of childhood and young adult cancer with a history of neck radiation followed in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering between November 2005 and August 2014. Eligible patients underwent a physical exam of the thyroid and were followed for at least 1 year afterwards. Ineligible patients were those with prior diagnosis of benign or malignant thyroid nodules.
During a median follow-up of 3.1 years (range 0-9.4 years), 106 ultrasounds and 2277 physical exams were performed among 585 patients. Forty survivors had an abnormal thyroid physical exam median of 21 years from radiotherapy; 50% of those with an abnormal exam were survivors of Hodgkin lymphoma, 60% had radiation at ages 10-19, and 53% were female. Ultimately, 24 underwent fine needle aspiration (FNA). Surgery revealed papillary carcinoma in seven survivors; six are currently free of disease and one with active disease is undergoing watchful waiting. Among those with one or more annual visits, representing 1732 person-years of follow-up, no cases of thyroid cancer were diagnosed within a year of normal physical exam.
These findings support the application of annual physical exam without routine ultrasound for thyroid cancer screening among survivors with a history of neck radiation.
Survivors with a history of neck radiation may not require routine thyroid ultrasound for thyroid cancer screening. Among adult survivors of childhood and young adult cancer with a history of radiation therapy to the neck, annual physical exam is an acceptable thyroid cancer screening strategy.
对于曾接受颈部放射治疗的儿童和青年期癌症幸存者，甲状腺癌的最佳筛查方法仍存在争议。缺乏基于体格检查的筛查方法的结局数据。
我们对在纪念斯隆-凯特琳癌症中心成人长期随访诊所就诊的曾接受颈部放射治疗的儿童和青年期癌症成年幸存者进行了回顾性研究，随访时间为 2005 年 11 月至 2014 年 8 月。符合条件的患者接受甲状腺体格检查，并在之后至少随访 1 年。不符合条件的患者为有良性或恶性甲状腺结节既往诊断的患者。
在中位数为 3.1 年（范围 0-9.4 年）的随访中，对 585 例患者进行了 106 次超声检查和 2277 次体格检查。40 例幸存者的甲状腺体格检查异常，距放射治疗中位数为 21 年；异常检查者中有 50%为霍奇金淋巴瘤幸存者，60%在 10-19 岁时接受放射治疗，53%为女性。最终，24 例行细针抽吸活检（FNA）。手术发现 7 例幸存者患有甲状腺乳头状癌；6 例目前无疾病，1 例有活动疾病者正在接受观察等待。在接受每年一次或多次就诊的患者中，代表 1732 人年的随访，在体格检查正常的一年内未诊断出甲状腺癌。
这些发现支持对曾接受颈部放射治疗的幸存者应用每年进行体格检查，而不常规进行甲状腺超声检查筛查甲状腺癌。在曾接受颈部放射治疗的儿童和青年期癌症成年幸存者中，每年进行体格检查是一种可接受的甲状腺癌筛查策略。
有颈部放射治疗史的幸存者可能不需要常规进行甲状腺超声检查筛查甲状腺癌。在曾接受颈部放射治疗的儿童和青年期癌症成年幸存者中，每年进行体格检查是一种可接受的甲状腺癌筛查策略。
