Crom D B, Kaste S C, Tubergen D G, Greenwald C A, Sharp G B, Hudson M M
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318, USA.
Med Pediatr Oncol. 1997 Jan;28(1):15-21. doi: 10.1002/(sici)1096-911x(199701)28:1<15::aid-mpo4>3.0.co;2-w.
We prospectively used ultrasonography to detect thyroid abnormalities in 96 long-term survivors of childhood cancer, who received head and neck radiation therapy at a median age of 8.9 years. The median time interval since irradiation was 10.8 years (range 5.6-22.8 years). Most survivors of leukemia received 24 Gy cranial irradiation for central nervous system prophylaxis; patients with solid tumors received between 20 and 66 Gy (median 37.5 Gy). The total evaluation included clinical history, physical examination, thyroid function tests, and thyroid ultrasonography; radionuclide scans were performed in patients whose abnormalities persisted on subsequent ultrasound exams. Clinical history and physical examination revealed thyroid abnormalities in 14 patients (15%), but ultrasound detected abnormalities in 42 patients (44%). These findings included inhomogeneity (n = 29), cysts (n = 15), and nodules (n = 22) and occurred in nearly half of patients treated with 15 Gy or more directly to the thyroid gland. Radionuclide scans confirmed the presence of thyroid nodules in 13 of 15 patients with ultrasonographic evidence of nodules. Six patients had thyroid neoplasia, including one case of papillary carcinoma. All patients with neoplasia had nodules demonstrated on ultrasonography. Our experience suggests that in childhood cancer survivors, ultrasonography is a sensitive, affordable, and noninvasive means of detecting subtle parenchymal abnormalities. We recommend thyroid ultrasonography for childhood cancer survivors who received head and neck irradiation. A baseline study should be obtained within 1 year of completion of therapy. The frequency of subsequent examinations should be based on the radiation dose and the patient's age at the time of irradiation.
我们前瞻性地运用超声检查，对96名儿童癌症长期幸存者的甲状腺异常情况进行检测。这些幸存者在8.9岁的中位年龄时接受了头颈部放射治疗。自放疗后的中位时间间隔为10.8年（范围5.6 - 22.8年）。大多数白血病幸存者接受24 Gy的颅脑照射以预防中枢神经系统疾病；实体瘤患者接受的照射剂量在20至66 Gy之间（中位剂量37.5 Gy）。全面评估包括临床病史、体格检查、甲状腺功能测试以及甲状腺超声检查；对于后续超声检查仍存在异常的患者，进行放射性核素扫描。临床病史和体格检查发现14名患者（15%）存在甲状腺异常，但超声检查发现42名患者（44%）存在异常。这些异常包括不均匀性（n = 29）、囊肿（n = 15）和结节（n = 22），在直接接受15 Gy或更高剂量甲状腺照射的患者中，近一半出现这些情况。放射性核素扫描证实，15名超声检查显示有结节的患者中，13名存在甲状腺结节。6名患者患有甲状腺肿瘤，包括1例乳头状癌。所有肿瘤患者超声检查均显示有结节。我们的经验表明，对于儿童癌症幸存者，超声检查是一种检测细微实质异常的敏感、经济且无创的方法。我们建议对接受过头颈部照射的儿童癌症幸存者进行甲状腺超声检查。应在治疗完成后1年内进行基线检查。后续检查的频率应根据放射剂量和放疗时患者的年龄来确定。
