Thyroid Cancer in Childhood Cancer Survivors: A Detailed Evaluation of Radiation Dose Response and its Modifiers

2006 ◽  
Vol 166 (4) ◽  
pp. 618-628 ◽  
Author(s):  
Cécile M. Ronckers ◽  
Alice J. Sigurdson ◽  
Marilyn Stovall ◽  
Susan A. Smith ◽  
Ann C. Mertens ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Radiation Dose ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Dose Response ◽  
Childhood Cancer Survivors ◽  
Detailed Evaluation

scholarly journals Absolute Risk Prediction of Second Primary Thyroid Cancer Among 5-Year Survivors of Childhood Cancer

2013 ◽  
Vol 31 (1) ◽  
pp. 119-127 ◽  
Author(s):  
Stephanie A. Kovalchik ◽  
Cécile M. Ronckers ◽  
Lene H.S. Veiga ◽  
Alice J. Sigurdson ◽  
Peter D. Inskip ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Thyroid Nodule ◽  
Absolute Risk ◽  
Childhood Cancer Survivors ◽  
Second Primary ◽  
Cancer Type ◽  
Risk Models ◽  
Treatment Information

Purpose We developed three absolute risk models for second primary thyroid cancer to assist with long-term clinical monitoring of childhood cancer survivors. Patients and Methods We used data from the Childhood Cancer Survivor Study (CCSS) and two nested case-control studies (Nordic CCSS; Late Effects Study Group). Model M1 included self-reported risk factors, model M2 added basic radiation and chemotherapy treatment information abstracted from medical records, and model M3 refined M2 by incorporating reconstructed radiation absorbed dose to the thyroid. All models were validated in an independent cohort of French childhood cancer survivors. Results M1 included birth year, initial cancer type, age at diagnosis, sex, and past thyroid nodule diagnosis. M2 added radiation (yes/no), radiation to the neck (yes/no), and alkylating agent (yes/no). Past thyroid nodule was consistently the strongest risk factor (M1 relative risk [RR], 10.8; M2 RR, 6.8; M3 RR, 8.2). In the validation cohort, 20-year absolute risk predictions for second primary thyroid cancer ranged from 0.04% to 7.4% for M2. Expected events agreed well with observed events for each model, indicating good calibration. All models had good discriminatory ability (M1 area under the receiver operating characteristics curve [AUC], 0.71; 95% CI, 0.64 to 0.77; M2 AUC, 0.80; 95% CI, 0.73 to 0.86; M3 AUC, 0.75; 95% CI, 0.69 to 0.82). Conclusion We developed and validated three absolute risk models for second primary thyroid cancer. Model M2, with basic prior treatment information, could be useful for monitoring thyroid cancer risk in childhood cancer survivors.

Ultrasound versus physical exam to screen for secondary thyroid cancer among high-risk childhood cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21528-e21528
Author(s):  
Jennifer Hess ◽  
Alexandra Maria Walsh ◽  
Dorothee Newbern ◽  
Kristian Schafernak ◽  
Tamara Vern-Gross ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Thyroid Cancer ◽  
High Risk ◽  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Physical Exam ◽  
Thyroid Malignancy ◽  
Head Neck

e21528 Background: Thyroid cancer is a common secondary malignancy among childhood cancer survivors who have received radiation to the head, neck and/or upper thorax. The optimal strategy for surveillance for thyroid carcinoma in childhood cancer survivors remains controversial. Current Children’s Oncology Group recommendations are limited to physical exam. The objective of this study was to determine the sensitivity and specificity of thyroid ultrasound versus neck exam by a pediatric endocrinologist in the diagnoses of thyroid cancer in a cohort of high-risk childhood cancer survivors. Methods: Medical records of childhood cancer survivors who received radiotherapy to the head, neck and/or upper thorax were reviewed. These patients were seen in a comprehensive childhood cancer survivorship clinic from 01/01/2010 to 12/31/2017. Patient populations included oncology, bone marrow transplant and brain tumor patients. Results: 226 patients received radiation to the head, neck and/or upper thorax. Of those, 129 patients were male (57%). Sixteen (7.1%) of patients developed a secondary thyroid malignancy including 4 patients previously treated for an oncological malignancy, 9 patients treated with bone marrow transplantation, and 3 patients with a CNS malignancy. Median radiation dose was 1800 cGy (range 400-5940 cGy). Time to thyroid carcinoma diagnosis occurred at a median of 12 years (range 4-19 years) from treatment with radiation. Screening ultrasounds were obtained in 146 (65%) patients while 226 (100%) had a physical exam. Two cases were identified by abnormalities on physical exam. The sensitivity of US was 100% (CI 80.6-100) compared to a sensitivity of 12.5% (CI 3.5-36) using physical exam (P < 0.0001). Screening ultrasound had a specificity of 73% (CI 65.1-80.1) while physical exam yielded a specificity of 100% (CI 98.2-100). Conclusions: Regular screening with ultrasounds provide the greatest sensitivity for detection of secondary thyroid carcinomas after head, neck and upper thorax radiation in childhood cancer survivors. If screening ultrasounds were not routinely utilized in our clinic, 14 of the 16 patients (87.5%) would have had a delay in their diagnosis of a secondary thyroid malignancy. Screening ultrasounds may lead to earlier detection of thyroid carcinomas, with the potential to decrease the need for aggressive surgery, radioiodine therapy and, ultimately, to decrease recurrence risk.

Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

2017 ◽  
Vol 97 (2) ◽  
pp. 278-286 ◽  
Author(s):  
Chiraz El-Fayech ◽  
Nadia Haddy ◽  
Rodrigue Sètchéou Allodji ◽  
Cristina Veres ◽  
Fara Diop ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Cerebrovascular Diseases

Correlation of long-term pulmonary injury with radiation dose distribution in childhood cancer survivors

2012 ◽  
Vol 2 (3) ◽  
pp. 237-240 ◽  
Author(s):  
Rajkumar Venkatramani ◽  
Arthur J. Olch ◽  
Leo Mascarenhas ◽  
Susanne Yoon ◽  
Batul Suterwala ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Dose Distribution ◽  
Childhood Cancer Survivors ◽  
Pulmonary Injury

scholarly journals Clinical considerations for the treatment of secondary differentiated thyroid carcinoma in childhood cancer survivors

2020 ◽  
Vol 183 (3) ◽  
pp. P1-P10
Author(s):  
Hanneke M van Santen ◽  
Erik K Alexander ◽  
Scott A Rivkees ◽  
Eva Frey ◽  
Sarah C Clement ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Differentiated Thyroid Carcinoma ◽  
Established Risk Factor ◽  
Number Of Patients ◽  
History Of ◽  
Clinical Considerations

The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience-based opinions of the authors.

Radiation dose to the pancreas and risk of diabetes mellitus in childhood cancer survivors: a retrospective cohort study

2012 ◽  
Vol 13 (10) ◽  
pp. 1002-1010 ◽  
Author(s):  
Florent de Vathaire ◽  
Chiraz El-Fayech ◽  
Faten Fedhila Ben Ayed ◽  
Nadia Haddy ◽  
Catherine Guibout ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Radiation Dose ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Childhood Cancer Survivors

Subsequent neoplasm risk associated with rare variants in DNA repair and clinical radiation sensitivity syndrome genes: A report from the Childhood Cancer Survivor Study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10028-10028
Author(s):  
Lindsay M. Morton ◽  
Danielle M Karyadi ◽  
Steven Hartley ◽  
Megan Frone ◽  
Joshua N Sampson ◽  
...  
Keyword(s):  
Dna Repair ◽  
Radiation Dose ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Rare Variants ◽  
Childhood Cancer Survivors ◽  
Radiation Sensitivity ◽  
Dna Break ◽  
Double Strand Dna

10028 Background: Radiotherapy for childhood cancer is associated with strikingly elevated risk for developing subsequent neoplasms (SNs). Whether mutations in DNA repair and radiation sensitivity genes modulate SN risks is largely unknown. Methods: We conducted whole-exome sequencing in 5105 long-term childhood cancer survivors of European descent (mean follow-up = 32.7 years). SnpEff and ClinVar identified potentially damaging rare variants in 476 DNA repair or radiation sensitivity genes. Conditional logistic regression assessed SN risk associated with these variants aggregated by gene or pathway (N = 155 with ≥5 carriers). Controls were matched on sex, childhood cancer type and diagnosis age, radiation dose to the SN site, and survival. Exact p-values were calculated by permutation. Analyses used all survivors or subsets stratified on radiation dose. Results: A total of 1108 (21.7%) survivors developed at least one SN type known to be related to ionizing radiation exposure (e.g., breast cancer, basal cell carcinoma, meningioma, thyroid cancer, sarcoma). Radiation-related SN risk was associated with homologous recombination (HR) gene variants for SN sites that received > 0- < 10 Gy (20.9% cases, 11.0% controls; odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.52-3.18; P = 1.41x10-4), most notably for FANCM (3.1% cases, 0.5% controls; OR = 9.91, 95%CI 3.73-26.4; P = 2.85x10-4). For radiation-related SNs at sites with higher doses (≥10 Gy), associations were not observed for the HR pathway (14.4% cases, 12.4% controls, P = 0.17) but were observed for two individual genes implicated in double-strand DNA break repair, EXO1 (1.8% cases, 0.4% controls; OR = 6.50, 95%CI 3.49-12.1; P = 7.43x10-4) and NEIL3 (0% cases, 1.0% controls; P = 3.23x10-4). Conclusions: In this discovery study, we identified dose-specific novel associations between SN risk after radiotherapy for childhood cancer and potentially damaging rare variants in genes involved in double-strand DNA break repair, particularly HR. If replicated, these results could impact long-term screening of childhood cancer survivors and risk-benefit assessments of treatment approaches.

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