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Hamilton SN, Mahdavi S, Martinez IS, Afghari N, Howard F, Tran E, Goddard K. A cross-sectional assessment of long-term effects in adolescent and young adult head and neck cancer survivors treated with radiotherapy. J Cancer Surviv 2021; 16:1117-1126. [PMID: 34542836 DOI: 10.1007/s11764-021-01103-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Adolescent and young adult (AYA) head and neck (H&N) cancer survivors are at risk of long-term complications. A cross-sectional study of survivors recalled for clinical evaluation was performed to evaluate late effects in this population. METHODS Surviving patients who had been diagnosed with H&N cancer between the ages of 15 and 39 years and treated with radiation therapy (RT) in British Columbia between 1970 and 2010 were invited to participate in this study. Survivors were assessed in consultation by a radiation oncologist for a complete history and physical exam. Comprehensive data collection of subjective and objective late effects of RT and screening investigations were completed. RESULTS Of 36 AYA H&N participants, the majority were female (61%), and the most common tumour sites were thyroid (28%), oropharynx (17%), salivary gland (14%) and larynx (14%). Dental extractions post treatment was performed for 33% and dental implants for 17%. The majority (72%) reported xerostomia, 50% had dysphagia to solids and 25% hearing loss. Of the non-thyroid cancer patients who underwent RT to their neck, 45% developed hypothyroidism. There were 28% of participants with asymptomatic carotid stenosis and 27% with thyroid nodules; all were diagnosed after recall screening. CONCLUSIONS Survivors of AYA H&N cancer treated with RT reported numerous long-term complications. Comprehensive follow-up and screening guidelines should be established for this at-risk population. IMPLICATIONS FOR CANCER SURVIVORS AYA H&N cancer survivors and their primary care practitioners should be educated on screening recommendations and the risk of late effects.
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Affiliation(s)
- Sarah Nicole Hamilton
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada. .,Univeristy of British Columbia, Vancouver, BC, Canada. .,, Vancouver, Canada.
| | - Sara Mahdavi
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | | | - Narsis Afghari
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
| | | | - Eric Tran
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
| | - Karen Goddard
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
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Sapuppo G, Tavarelli M, Cannata E, La Spina M, Russo M, Scollo C, Spadaro A, Masucci R, Lo Nigro L, Russo G, Di Cataldo A, Pellegriti G. Risk of Benign and Malignant Thyroid Disorders in Subjects Treated for Paediatric/Adolescent Neoplasia: Role of Morphological and Functional Screening. CHILDREN-BASEL 2021; 8:children8090767. [PMID: 34572198 PMCID: PMC8468117 DOI: 10.3390/children8090767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
Background: Patients treated for paediatric/adolescent (P/A) neoplasia have a high incidence of both benign and malignant thyroid diseases. Given the high incidence of sequelae, literature data show a clinical benefit of morpho-functional thyroid screening in paediatric/adolescent cancer survivors and a careful lifetime follow-up. Patients and methods: The incidence of thyroid alterations was evaluated in a consecutive series of 343 patients treated with chemotherapy (CHE) and radiotherapy (RTE) or only with CHE for P/A tumours between 1976 and 2018 (mean age at time of primary paediatric malignancy 7.8 ± 4.7 years). All patients underwent thyroidal morpho-functional evaluation between 2000 and 2019. Results: 178 patients (51.9%) were treated only with CHE and 165 (48.1%) with CHE+RTE. A functional and/or structural thyroid disease was diagnosed in 147 (42.5%; 24.2% in CHE and 62.4% in CHE+RTE group; p = 0.0001). Of note, 71 (20.7%) patients with no evidence of disease at first evaluation developed a thyroid alteration during the follow-up. Primitive hypothyroidism was diagnosed in 54 patients (15.7%; 11.2% in CHE vs. 20.6% in CHE+RTE group; p = 0.01) and hyperthyroidism in 4. Sixty-three patients developed thyroid nodules (18.4%; 4.0% in CHE and 14.1% in CHE+RTE group; p < 0.001); thyroid cancer was diagnosed in 30 patients (8.7%; 4.5% in CHE and 12.4% in CHE + RTE group; p = 0.007). Conclusions: In patients treated with CHE+RTE, the prevalence of hypothyroidism and nodular pathology, both malignant and benign, were significantly greater than in patients treated with CHE. However, also in the CHE group, the frequency of thyroid disease is not negligible and the pathogenetic mechanisms remain to be clarified. Our data suggest the clinical benefit of morpho-functional thyroid screening in P/A cancer survivors.
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Affiliation(s)
- Giulia Sapuppo
- Endocrinology, Garibaldi-Nesima Medical Center, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy;
| | - Martina Tavarelli
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Emanuela Cannata
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Milena La Spina
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Marco Russo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Claudia Scollo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Angela Spadaro
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Romilda Masucci
- Garibaldi-Nesima Medical Center, Department of Surgical Oncology, 95122 Catania, Italy;
| | - Luca Lo Nigro
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Giovanna Russo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Andrea Di Cataldo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Gabriella Pellegriti
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
- Correspondence:
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Geurts JL, Strong EA, Wang TS, Evans DB, Clarke CN. Screening guidelines and recommendations for patients at high risk of developing endocrine cancers. J Surg Oncol 2020; 121:975-983. [DOI: 10.1002/jso.25869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Jennifer L. Geurts
- Graduate School of Biomedical SciencesMedical College of WisconsinMilwaukee Wisconsin
| | - Erin A. Strong
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Tracy S. Wang
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Douglas B. Evans
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Callisia N. Clarke
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
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Abstract
The presence of a thyroid nodule may be recognized by the patient or the clinician on palpation of the neck or it may be an incidental finding during an imaging study for some other indication. The method of detection is less important, however, than distinguishing benign lesions from more aggressive neoplasms. This article outlines the diagnostic algorithm for the evaluation of thyroid nodules including biochemical testing, imaging, and, when appropriate, fine-needle aspiration. In addition, the authors review the natural history of benign nodules, follow-up strategies, and indications for repeat aspiration.
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Affiliation(s)
- Carolyn Maxwell
- Division of Endocrinology and Metabolism, Stony Brook University School of Medicine, 26 Research Way, East Setauket, NY 11733, USA
| | - Jennifer A Sipos
- Division of Endocrinology and Metabolism, The Ohio State University Wexner Medical Center, 1581 Dodd Drive, 5th Floor McCampbell Hall, South, Columbus, OH 43210, USA.
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Ogle S, Merz A, Parina R, Alsayed M, Milas M. Ultrasound and the Evaluation of Pediatric Thyroid Malignancy: Current Recommendations for Diagnosis and Follow-up. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2311-2324. [PMID: 29575028 DOI: 10.1002/jum.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 06/08/2023]
Abstract
Ultrasound (US) plays a critical role in the evaluation, treatment, screening, and surveillance of thyroid malignancy in pediatric patients. This review aims to summarize recent advances in this topic. Improvements in imaging technology have amplified the advantage of US and US-guided fine-needle aspiration biopsy for thyroid nodule evaluation, cancer diagnosis, and surgical planning. Ultrasound has a definitive screening role for early cancer detection in high-risk patients, including those with a history of radiation exposure from childhood treatments, environmental radiation disasters, or hereditary/familial cancer syndromes. Finally, US is a key component of lifelong surveillance for recurrence among pediatric thyroid cancer survivors.
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Affiliation(s)
- Sarah Ogle
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Alexa Merz
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Ralitza Parina
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mahmoud Alsayed
- Department of Endocrinology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mira Milas
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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The prevalence of thyroid nodules in northwest China and its correlation with metabolic parameters and uric acid. Oncotarget 2018; 8:41555-41562. [PMID: 28107199 PMCID: PMC5522227 DOI: 10.18632/oncotarget.14720] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022] Open
Abstract
This study aimed to estimate the prevalence of thyroid nodules (TN) and investigate its correlation with metabolic parameters, especially uric acid (UA) in northwest Chinese population. We conducted a large cross-sectional survey with 67,781 residents (33,020 men, 34,761 women), aged from 18 to 86 years in Shanxi, China, from January 2012 to December 2014. A thyroid ultrasound examination was performed with number and size of nodules being recorded. Metabolic parameters including body mass index (BMI), blood pressure (BP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glucose (FG), and uric acid (UA) were also examined. Our study revealed that approximately 30.7% of men and 39.9% of women in Northwest China had TN, about half of which were multi-nodularity and a quarter of their TN larger than 1 cm. The prevalence of TN increased with aging and increasing BMI, and metabolic disorders, which also related to the increased incident of multi-nodularity and larger TN. Serum UA appeared to be a protective factor for TN in men older than 30 years, but a risk factor in both men younger than 30 years and women older than 30 years. This phenomenon needs to be further investigated.
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Complicaciones endocrinas precoces en supervivientes de neoplasias infantiles. Med Clin (Barc) 2016; 147:329-333. [DOI: 10.1016/j.medcli.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/21/2022]
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Wijnen M, van den Heuvel-Eibrink MM, Medici M, Peeters RP, van der Lely AJ, Neggers SJCMM. Risk factors for subsequent endocrine-related cancer in childhood cancer survivors. Endocr Relat Cancer 2016; 23:R299-321. [PMID: 27229933 DOI: 10.1530/erc-16-0113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/26/2016] [Indexed: 12/12/2022]
Abstract
Long-term adverse health conditions, including secondary malignant neoplasms, are common in childhood cancer survivors. Although mortality attributable to secondary malignancies declined over the past decades, the risk for developing a solid secondary malignant neoplasm did not. Endocrine-related malignancies are among the most common secondary malignant neoplasms observed in childhood cancer survivors. In this systematic review, we describe risk factors for secondary malignant neoplasms of the breast and thyroid, since these are the most common secondary endocrine-related malignancies in childhood cancer survivors. Radiotherapy is the most important risk factor for secondary breast and thyroid cancer in childhood cancer survivors. Breast cancer risk is especially increased in survivors of Hodgkin lymphoma who received moderate- to high-dosed mantle field irradiation. Recent studies also demonstrated an increased risk after lower-dose irradiation in other radiation fields for other childhood cancer subtypes. Premature ovarian insufficiency may protect against radiation-induced breast cancer. Although evidence is weak, estrogen-progestin replacement therapy does not seem to be associated with an increased breast cancer risk in premature ovarian-insufficient childhood cancer survivors. Radiotherapy involving the thyroid gland increases the risk for secondary differentiated thyroid carcinoma, as well as benign thyroid nodules. Currently available studies on secondary malignant neoplasms in childhood cancer survivors are limited by short follow-up durations and assessed before treatment regimens. In addition, studies on risk-modifying effects of environmental and lifestyle factors are lacking. Risk-modifying effects of premature ovarian insufficiency and estrogen-progestin replacement therapy on radiation-induced breast cancer require further study.
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Affiliation(s)
- M Wijnen
- Department of Pediatric Oncology/HematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands Department of MedicineSection Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M M van den Heuvel-Eibrink
- Department of Pediatric Oncology/HematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands Princess Maxima Center for Pediatric OncologyUtrecht, the Netherlands
| | - M Medici
- Department of MedicineSection Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands Rotterdam Thyroid CenterErasmus University Medical Center, Rotterdam, the Netherlands
| | - R P Peeters
- Department of MedicineSection Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands Rotterdam Thyroid CenterErasmus University Medical Center, Rotterdam, the Netherlands
| | - A J van der Lely
- Department of MedicineSection Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S J C M M Neggers
- Department of Pediatric Oncology/HematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands Department of MedicineSection Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
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