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Garcés-Visier C, Conejero-Gonzalez P, Andión-Catalán M, Martín-Vega A, Muñoz-Hernández D, Espinoza-Vega ML, Luis-Huertas AL, Alonso-Calderón JL. Thyroid abnormalities in patients with Hodgkin lymphoma: The importance of close surveillance. An Pediatr (Barc) 2024; 100:325-332. [PMID: 38644086 DOI: 10.1016/j.anpede.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/21/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Survival in paediatric patients with Hodgkin lymphoma (HL) has increased over the last decades. However, these patients are at increased risk of developing late thyroid sequelae due to the treatment with irradiation and alkylating agents. METHODS We conducted an observational and retrospective study in patients with a diagnosis of HL between 2007 and 2022, in a hospital that is a paediatric oncology reference centre, through the review of electronic health records. We collected data on demographic (age, sex), clinical, radiological and histopathological variables, the dosage of alkylating agents and radiotherapy (RT) and on thyroid disorders using Microsoft Excel. The data analysis was conducted with SPSS version 17, using the Fisher exact test for qualitative data, a nonparametric test for quantitative data and Kaplan-Meier curves. RESULTS Sixty patients received a diagnosis of HL from 2007 to 2022. The median duration of follow-up was 78.5 months. There were 4 detected cases of hypothyroidism, 5 of thyroid nodules and 1 of subclinical hyperthyroidism. Treatment with RT was significantly associated with the development of hypothyroidism (P= .026), thyroid nodules (P= .01) and thyroid disease overall (P= .003). We estimated that the risk of thyroid disease increased 8-fold with each additional Grey received (hazard ratio, 1.081; 95% CI, 1.014-1.152; P= .017). CONCLUSION Hodgkin lymphoma patients treated with RT are at increased risk of late thyroid disorders, mainly hypothyroidism and malignancy. This risk is greater the higher the RT dosage and the longer the follow-up. We did not find evidence of an association between the use of alkylating agents and an increase in the risk of thyroid disease.
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Affiliation(s)
- Cristina Garcés-Visier
- Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | | | - Alberto Martín-Vega
- Medicina Preventiva, Centros, Servicios y Unidades de Referencia (CSUR), Spain
| | - Diego Muñoz-Hernández
- Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Cuellar Cuellar AA, Cuellar Rivera DI, Fierro-Maya LF, Posso Valencia H. Exposure to radiotherapy for first primary cancer as a risk factor for second primary thyroid cancer: A case-control study. ANNALES D'ENDOCRINOLOGIE 2020; 81:539-544. [PMID: 33290749 DOI: 10.1016/j.ando.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Second primary neoplasms are associated with high mortality and morbidity rates in cancer survivors successfully treated for the first malignancy. Studies suggested an association between the type of first neoplasm and risk of subsequent thyroid cancer, with part of this risk attributable to exposure to radiotherapy during treatment of the first primary tumor. This study aimed to determine whether radiotherapy is a risk factor for thyroid cancer in patients previously treated for another neoplasm. METHODS This retrospective case-control study included patients diagnosed with their first cancer between 2007 and 2017. Patients who subsequently developed thyroid cancer as a second primary neoplasm were defined as "cases", and patients who did not develop a second cancer were defined as "controls". Exposure to radiotherapy was the primary risk factor of interest; other risk factors were the site to which radiotherapy was delivered and the first neoplasm type. RESULTS Exposure to radiotherapy was associated with an increased risk of thyroid cancer (odds ratio [OR]=2.410, 95% confidence interval [CI]: 1.219-4.764), in particular, in women (OR=3.121, 95% CI: 1.232-7.907) and in patients receiving radiotherapy to the thorax (OR=6.298, 95% CI: 2.581-15.370). The median survival time from first cancer recovery to thyroid cancer occurrence was 63.80 months; there was no difference in survival between patients who did and did not receive radiotherapy (P=0.899). CONCLUSION Radiation to the thorax can increase the risk of thyroid cancer as a second neoplasm among patients with cancer successfully treated for their first cancer.
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Affiliation(s)
- Andrés Arturo Cuellar Cuellar
- Endocrine Oncology Unit, Instituto Nacional de Cancerología, Bogotá Colombia, Colombia; CES - Universidad del Rosario Epidemiology Magister, Bogotá Colombia, Colombia.
| | - Diana Isabel Cuellar Rivera
- Clinical and Epidemiological Cancer Research Unit, Instituto Nacional de Cancerología, Bogotá Colombia, Colombia
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3
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Zirilli G, Valenzise M, Dionigi G, Tuccari G, Romeo C, Campennì A, Corrias A, Tuli G, Ieni A, Pajno GB, Wasniewska M. Hurthle cell carcinoma in childhood: A retrospective analysis of five cases and review of pediatric literature. Pediatr Blood Cancer 2020; 67:e28300. [PMID: 32614144 DOI: 10.1002/pbc.28300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND the available studies on Hurthle cell carcinoma (HCC) in pediatric age are scarce and based on isolated case reports. Aims of the present study were to review the available pediatric literature on HCC (2000-2019), to describe the cohort of children with this cancer histotype, and to estimate its relative prevalence in pediatric age. PROCEDURE We retrospectively reconstructed an HCC course in five patients < 19 years who were identified in our departments during the period 2000-2019, and we reviewed the available pediatric studies on this differentiated thyroid cancer (DTC) variant. RESULTS HCC occurred with a relative prevalence of 5.8% at a median chronological age of 12.5 years. None of HCC patients exhibited, at diagnosis, thyroid dysfunction, extensive lateral neck disease, or distant metastases, and all showed a persistent remission over time. Three patients showed, at diagnosis, antecedents of other diseases (Hashimoto's thyroiditis, neurofibromatosis type 1, and osteosarcoma). CONCLUSIONS (1) In childhood, the relative prevalence of HCC among different thyroid cancer histotypes is 5.8%, that is close to the one previously reported both in the general population and in other less numerous children's cohorts; (2) HCC may develop even early, at the age of 7; (3) in childhood, HCC does not seem to have a more aggressive behavior when compared with other DTC histotypes; (4) antecedents of other diseases are not infrequent in the history of children with HCC.
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Affiliation(s)
- Giuseppina Zirilli
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Carmelo Romeo
- Division of Pediatric Surgery, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Andrea Corrias
- Division of Pediatric Endocrinology, Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Gerdi Tuli
- Division of Pediatric Endocrinology, Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Ieni
- Section of Pathological Anatomy, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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4
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Lorenz E, Scholz-Kreisel P, Baaken D, Pokora R, Blettner M. Radiotherapy for childhood cancer and subsequent thyroid cancer risk: a systematic review. Eur J Epidemiol 2018; 33:1139-1162. [PMID: 30511135 DOI: 10.1007/s10654-018-0467-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
Abstract
Most of the pooled analyses and reviews reported an association between radiotherapy for childhood cancer and an increased thyroid cancer risk. Up to now this article presents the first systematic literature review on this association combined with a critical assessment of the methodological quality of the included articles. PubMed and Web of Science databases were searched for relevant articles until May 2016. We included peer-reviewed cohort and case-control studies that investigated an association between radiotherapy for childhood cancer and the occurrence of subsequent thyroid cancer. A systematic overview is presented for the included studies. We identified 17 retrospective cohort studies, and four nested case-control studies, representing 100,818 subjects. The age range at first cancer diagnosis was 0-25.2 years. Considerable variability was found regarding study sizes, study design, treatment strategies, dose information, and follow-up periods. 20 of the 21 identified studies showed increased thyroid cancer risks associated with childhood radiation exposure. The large majority showed an increased relative risk or odds ratio confirming the association between radiotherapy and thyroid cancer although the variation in results was large. Additionally to a pooled analysis that has been published recently, we systematically included 17 further studies, which allowed us to cover information from countries that were not covered by large-scale childhood cancer survivor studies. The methodological limitations of existing studies and inconsistencies in findings across studies yielded a large study heterogeneity, which made a detailed comparison of study results difficult. There is a need to strengthen standardisation for reporting.
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Affiliation(s)
- Eva Lorenz
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany. .,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
| | - Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Dan Baaken
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, 55101, Mainz, Germany
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5
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Deseyne P, Speleers B, De Neve W, Boute B, Paelinck L, Van Hoof T, Van de Velde J, Van Greveling A, Monten C, Post G, Depypere H, Veldeman L. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat Oncol 2017; 12:89. [PMID: 28549483 PMCID: PMC5446717 DOI: 10.1186/s13014-017-0828-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Prone whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI). Methods A new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position. Results Target volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses. Conclusions Prone crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses. Trial registration No trial registration was performed because there were no therapeutic interventions.
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Affiliation(s)
- Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium. .,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium.
| | - Bruno Speleers
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Bert Boute
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium.,Industrial Design Centre - Department of Industrial Systems Engineering and Product Design (EA18), Faculty of Engineering and Architecture, Ghent University, Campus Kortrijk, Graaf Karel de Goedelaan 5, Kortrijk, B-8500, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Tom Van Hoof
- Department of Anatomy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Joris Van de Velde
- Department of Anatomy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Annick Van Greveling
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Giselle Post
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Herman Depypere
- Department of Obstetrics and Gynaecology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Uro-gynaecology, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, B-9000, Belgium
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6
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Ronckers CM, Tytgat L, van den Heuvel-Eibrink MM, Teepen J, Kremer LCM, Clement S, van Santen HM. RE: Incidence and risk factors for secondary malignancy in patients with neuroblastoma after treatment with 131-I-metaiodobenzylguanidine. Huibregtse K et al. European Journal of Cancer 2016. 66:144-152. Eur J Cancer 2017; 77:21-23. [PMID: 28359832 DOI: 10.1016/j.ejca.2017.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Cecile M Ronckers
- Emma Children's Hospital/Academic Medical Center (AMC), Department of Pediatric Oncology, Amsterdam, The Netherlands; Dutch Childhood Oncology Group/Late Effects After Childhood Cancer (DCOG-LATER) Consortium, The Netherlands.
| | - Lieve Tytgat
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Dutch Childhood Oncology Group/Late Effects After Childhood Cancer (DCOG-LATER) Consortium, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jop Teepen
- Emma Children's Hospital/Academic Medical Center (AMC), Department of Pediatric Oncology, Amsterdam, The Netherlands
| | - Leontine C M Kremer
- Emma Children's Hospital/Academic Medical Center (AMC), Department of Pediatric Oncology, Amsterdam, The Netherlands; Dutch Childhood Oncology Group/Late Effects After Childhood Cancer (DCOG-LATER) Consortium, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sarah Clement
- Vrije Universiteit, Department of Pediatrics, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Endocrinology, Utrecht, The Netherlands
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7
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Hegemann NS, Schlesinger-Raab A, Ganswindt U, Hörl C, Combs SE, Hölzel D, Gschwend JE, Stief C, Belka C, Engel J. Risk of second cancer following radiotherapy for prostate cancer: a population-based analysis. Radiat Oncol 2017; 12:2. [PMID: 28049538 PMCID: PMC5209816 DOI: 10.1186/s13014-016-0738-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/06/2016] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the risk of second cancer and radiation induced second cancer following prostate cancer radiotherapy. Methods We compared men with radiotherapy only with those treated with radical prostatectomy only and those with radiotherapy after radical prostatectomy. Cumulative incidences of second cancers were calculated. Cox analyses were performed to identify determinants influencing second cancer incidence. Results Nineteen thousand five hundred thirty eight patients were analyzed. Age and median follow-up differed significantly with radiotherapy only patients having the highest median age (70.3 years) and radical prostatectomy only patients the longest median follow-up (10.2 years). Ten-year cumulative incidence of second cancer was 15.9%, 13.2% and 10.5% for patients with radiotherapy only, radiotherapy after radical prostatectomy and radical prostatectomy only (p <0.0001). Increasing age and belonging to the radiotherapy only group were associated with a higher risk of second cancer—no significant increase was seen in radiotherapy after radical prostatectomy patients. A significantly higher rate of smoking related malignancies, like lung, bladder and non-melanoma skin cancer, was seen in radiotherapy only patients. Conclusions No clear increase in radiation induced second cancer was found in patients after radiotherapy for prostate cancer. Whereas the rate of second cancer was increased in radiotherapy only patients, no such increase was seen in patients with radiotherapy after radical prostatectomy. The increase of second cancer following radiotherapy only is highly likely to reflect advanced age and lifestyle habits and comorbidities.
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Affiliation(s)
- Nina-Sophie Hegemann
- Department of Radiation Oncology, Klinikum der Universität, Ludwig-Maximilians-University, LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - Anne Schlesinger-Raab
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Klinikum der Universität, Ludwig-Maximilians-University, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Claudia Hörl
- Department of Radiotherapy, Klinikum Schwabing, Kölner Pl 1, 80804, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University (TU), Ismaningerstr 22, 81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Centre, Munich, Germany
| | - Dieter Hölzel
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum Rechts der Isar, Technical University (TU), Ismaningerstr 22, 81675, Munich, Germany
| | - Christian Stief
- Department of Urology, Klinikum der Universität, Ludwig-Maximilians-University, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, Klinikum der Universität, Ludwig-Maximilians-University, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistr 15, 81377, Munich, Germany
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8
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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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9
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Casagranda L, Oriol M, Freycon F, Frappaz D, Bertrand Y, Bergeron C, Plantaz D, Stephan JL, Freycon C, Gomez F, Berger C, Trombert-Paviot B. Second malignant neoplasm following childhood cancer: A nested case-control study of a recent cohort (1987-2004) from the Childhood Cancer Registry of the Rhône-Alpes region in France. Pediatr Hematol Oncol 2016; 33:371-382. [PMID: 27687523 DOI: 10.1080/08880018.2016.1214653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
From a population-based cohort of cases of first cancers diagnosed between 1987 and 2004, before the patient's age of 15 years, the authors conducted a nested case-control study, matching 64 patients who experienced a second malignant neoplasm (SMN) with 190 controls. SMNs comprised 10 leukemia or myelodysplastic syndromes, 5 lymphomas induced by Epstein-Barr virus after allograft, and 49 solid tumors, including mainly 25 carcinomas (17 of the thyroid), 9 bone sarcomas, and 7 central nervous system (CNS) tumors. The median latency occurrence was 6.5 years, and that of thyroid carcinomas induced by 12 Gy fractioned total body irradiation (TBI) was 7.6 years. The relative risk (RR) of an SMN was increased by genetic and family factors and increased 17 to 69 times according to the dose of radiotherapy administered in the region for the first cancer. Age younger than 4 years at the time of radiotherapy increased the risk of SMN. Chemotherapy adjusted according to the dose of radiotherapy administered in the field yielded a greater RR of an SMN only for cumulative doses exceeding 2 g/m2 of epipodophyllotoxin but not for alkylating agents or platinum compounds. The RR of secondary leukemia increased 10-fold following high doses of epipodophyllotoxin >2 g/m2 but was not affected by alkylating agents or anthracyclines. The crude RR of a solid SMN developing after radiotherapy was very high at 18 and reached 90.7 for thyroid carcinoma after TBI, whereas the authors observed no increased risk associated with chemotherapy. These results confirm the risk of secondary leukemia after epipodophyllotoxin and of solid tumor after radiotherapy.
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Affiliation(s)
- L Casagranda
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - M Oriol
- d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
| | - F Freycon
- c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - D Frappaz
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - Y Bertrand
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - C Bergeron
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - D Plantaz
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - J L Stephan
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France
| | - C Freycon
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - F Gomez
- g Centre Léon Bérard , Lyon , France
| | - C Berger
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - B Trombert-Paviot
- b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France.,d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
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10
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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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