Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Horm Res Paediatr. 2024;97(3):243-253. doi: 10.1159/000531241. Epub 2023 Sep 18.
Childhood cancer survivors (CCS) are at risk for radiotherapy (RT) late effects, including second malignancies. Optimal screening for differentiated thyroid cancer (DTC) in CCS post-RT remains controversial. We assessed the outcome of thyroid ultrasound (US) surveillance in CCS exposed to RT.
306 CCS were surveilled with thyroid US between 2002-2021. Surveillance was dependent on age at the time of primary diagnosis, interval from receipt of RT, and individual provider. Thyroid US, clinicopathologic features, and outcomes were described. Cutpoints of CCS RT age associated with varying risk of nodule presentation were explored. The selected cutpoints were used to define age categories, which were then used to compare thyroid nodule-related outcomes. Risk factors for thyroid nodule(s) were evaluated using multivariate logistic regression (odds ratio [OR] [95% confidence interval]).
The most common CCS diagnoses were leukemia (32%), CNS tumor (26%), and neuroblastoma (18%). Patients received TBI (45%) and/or RT to craniospinal (44%), chest (11%), and neck regions (6%). About 49% (n = 150) of patients had thyroid nodule(s). Forty-four patients underwent surgery, and 28 had DTC: 19 with American Thyroid Association (ATA) low-risk classification, 2 with ATA intermediate-risk, and 7 with ATA high-risk disease. Age cutpoint analyses identified cutpoints 3 and 10; hence, ≤3, >3 to ≤10, and >10 years were used. Of the 9 patients with intermediate- or high-risk disease, 8 were ≤10 years and 1 was >10 years at the time of RT. Female sex (OR = 1.62 [1.13-2.12] p = 0.054) and greater interval between RT and first US (OR = 1.10 [1.04-1.16] p = 0.001) were independent risk factors for nodule presentation.
Thyroid US surveillance may be beneficial for CCS exposed to RT at younger ages (≤10 years) for earlier detection of DTC, prior to developing advanced metastatic disease.
儿童癌症幸存者（CCS）存在放射治疗（RT）后晚期效应的风险，包括第二恶性肿瘤。RT 后 CCS 分化型甲状腺癌（DTC）的最佳筛查仍存在争议。我们评估了接受 RT 的 CCS 甲状腺超声（US）监测的结果。
2002 年至 2021 年间，对 306 名 CCS 进行了甲状腺 US 监测。监测取决于初次诊断时的年龄、接受 RT 的间隔时间和个体提供者。描述了甲状腺 US、临床病理特征和结果。探讨了与结节表现风险不同的 CCS RT 年龄的切点。选择的切点用于定义年龄类别，然后用于比较与甲状腺结节相关的结果。使用多元逻辑回归（优势比[OR] [95%置信区间]）评估甲状腺结节的危险因素。
最常见的 CCS 诊断是白血病（32%）、中枢神经系统肿瘤（26%）和神经母细胞瘤（18%）。患者接受了全脑放疗（45%）和/或颅脊髓放疗（44%）、胸部放疗（11%）和/或颈部放疗（6%）。约 49%（n=150）的患者有甲状腺结节。44 名患者接受了手术，其中 28 名患有 DTC：19 名患者为美国甲状腺协会（ATA）低危分类，2 名患者为 ATA 中危，7 名患者为 ATA 高危疾病。年龄切点分析确定了 3 和 10 两个切点；因此，≤3 岁、＞3 至≤10 岁和＞10 岁。在有中危或高危疾病的 9 名患者中，8 名患者在 RT 时≤10 岁，1 名患者＞10 岁。女性（OR=1.62 [1.13-2.12]，p=0.054）和 RT 与首次 US 之间间隔时间更长（OR=1.10 [1.04-1.16]，p=0.001）是结节出现的独立危险因素。
对于接受 RT 治疗的年龄较小（≤10 岁）的 CCS，甲状腺 US 监测可能有助于早期发现 DTC，防止其发展为晚期转移性疾病。
