Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pediatrics, Amsterdam University Medical Center location VU Medical Center, Amsterdam, The Netherlands.
Eur J Endocrinol. 2020 Aug;183(2):169-180. doi: 10.1530/EJE-20-0153.
Childhood cancer survivors (CCS) are at increased risk to develop differentiated thyroid cancer predominantly after radiotherapy (subsequent DTC). It is insufficiently known whether subsequent DTC in CCS has a different presentation or outcome than sporadic DTC.
Patients with subsequent DTC (n = 31) were matched to patients with sporadic DTC (n = 93) on gender, age and year of diagnosis to compare presentation and DTC outcomes. Clinical data were collected retrospectively.
Among the CCS with subsequent DTC, all but one had received chemotherapy for their childhood cancer, 19 (61.3%) had received radiotherapy including the thyroid region, 3 (9.7%) 131I-MIBG and 8 (25.8%) had received treatment with chemotherapy only. Subsequent DTC was detected by surveillance through neck palpation (46.2%), as a self-identified mass (34.6%), or by chance. Among sporadic DTC patients, self detection predominated (68.8%). CCS with subsequent DTC tended to have on average smaller tumors (1.9 vs 2.4 cm, respectively, (P = 0.051), and more often bilateral (5/25 (60.0%) vs 28/92 (30.4%), P = 0.024). There were no significant differences in the occurrence of surgical complications, recurrence rate or disease-related death.
When compared to patients with sporadic DTC, CCS with subsequent DTC seem to present with smaller tumors and more frequent bilateral tumors. Treatment outcome seems to be similar. The finding that one-third of subsequent DTC cases had been treated with chemotherapy only needs further investigation. These results are important for the development of surveillance programs for CCS at risk for DTC and for treatment guidelines of subsequent DTC.
儿童癌症幸存者（CCS）在接受放疗（随后的 DTC）后，主要患有分化型甲状腺癌（DTC）的风险增加。尚不清楚 CCS 中随后发生的 DTC 是否与散发性 DTC 具有不同的表现或结局。
对随后患有 DTC（n=31）的患者与散发性 DTC（n=93）患者进行性别、年龄和诊断年份的匹配，以比较表现和 DTC 结局。临床数据进行回顾性收集。
在患有随后的 DTC 的 CCS 中，除 1 例外，所有患者均因儿童癌症接受过化疗，19 例（61.3%）接受过包括甲状腺区域在内的放疗，3 例（9.7%）接受过 131I-MIBG 治疗，8 例（25.8%）仅接受过化疗。随后的 DTC 通过颈部触诊（46.2%）、自我识别的肿块（34.6%）或偶然发现。在散发性 DTC 患者中，自我检测占主导地位（68.8%）。CCS 随后发生的 DTC 平均肿瘤较小（分别为 1.9 厘米和 2.4 厘米，（P=0.051），且更常为双侧（5/25（60.0%）vs 28/92（30.4%），P=0.024）。手术并发症、复发率或疾病相关死亡率无显著差异。
与散发性 DTC 患者相比，CCS 随后发生的 DTC 似乎表现为肿瘤较小，双侧肿瘤更为常见。治疗结果似乎相似。需要进一步调查三分之一的随后 DTC 病例仅接受化疗治疗的情况。这些结果对于开发有 DTC 风险的 CCS 监测计划和随后 DTC 的治疗指南很重要。
