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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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Balasubramanian JB, Choudhury PP, Mukhopadhyay S, Ahearn T, Chatterjee N, García-Closas M, Almeida JS. Wasm-iCARE: a portable and privacy-preserving web module to build, validate, and apply absolute risk models. JAMIA Open 2024; 7:ooae055. [PMID: 38938691 PMCID: PMC11208928 DOI: 10.1093/jamiaopen/ooae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/24/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Objectives Absolute risk models estimate an individual's future disease risk over a specified time interval. Applications utilizing server-side risk tooling, the R-based iCARE (R-iCARE), to build, validate, and apply absolute risk models, face limitations in portability and privacy due to their need for circulating user data in remote servers for operation. We overcome this by porting iCARE to the web platform. Materials and Methods We refactored R-iCARE into a Python package (Py-iCARE) and then compiled it to WebAssembly (Wasm-iCARE)-a portable web module, which operates within the privacy of the user's device. Results We showcase the portability and privacy of Wasm-iCARE through 2 applications: for researchers to statistically validate risk models and to deliver them to end-users. Both applications run entirely on the client side, requiring no downloads or installations, and keep user data on-device during risk calculation. Conclusions Wasm-iCARE fosters accessible and privacy-preserving risk tools, accelerating their validation and delivery.
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Affiliation(s)
- Jeya Balaji Balasubramanian
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
| | - Parichoy Pal Choudhury
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA 30303, United States
| | - Srijon Mukhopadhyay
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
| | - Thomas Ahearn
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
| | - Nilanjan Chatterjee
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Montserrat García-Closas
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
- The Cancer Epidemiology and Prevention Research Unit, The Institute of Cancer Research, London, SM2 5NG, United Kingdom
| | - Jonas S Almeida
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, United States
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Song C, Luo JY, Pang YY, He RQ, Li XJ, Chen G, Zhao CY, Qu N, Chen YM, Yang L, Li BQ, Shi L. Historical context, process, and development trends of pediatric thyroid cancer research: a bibliometric analysis. Front Oncol 2024; 14:1340872. [PMID: 38463235 PMCID: PMC10921230 DOI: 10.3389/fonc.2024.1340872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Objective At present, the structure of knowledge in the field of childhood thyroid cancer is not clear enough, and scholars lack a sufficient understanding of the developing trends in this field, which has led to a shortage of forward-looking outputs. The purpose of this research is to help scholars construct a complete knowledge framework and identify current challenges, opportunities, and development trends. Methods We searched the literature in the Web of Science Core Collection database on August 7, 2023 and extracted key information from the top 100 most cited articles, such as the countries, institutions, authors, themes, and keywords. We used bibliometric tools such as bibliometrix, VOSviewer, and CiteSpace for a visualization analysis and Excel for statistical descriptions. Results The top 100 most cited articles fluctuated over time, and the research was concentrated in European countries, the United States, and Japan, among which scientific research institutions and scholars from the United States made outstanding contributions. Keyword analysis revealed that research has shifted from simple treatment methods for pediatric thyroid cancer (total thyroidectomy) and inducing factors (the Chernobyl power station accident) to the clinical applications of genetic mutations (such as the BRAF and RET genes) and larger-scale genetic changes (mutation studies of the DICER1 gene). The thematic strategy analysis showed an increasing trend towards the popularity of fusion oncogenes, while the popularity of research on traditional treatments and diagnostics has gradually declined. Conclusion Extensive research has been conducted on the basic problems of pediatric thyroid cancer, and there has been significant outputs in the follow-up and cohort analysis of conventional diagnostic and treatment methods. However, these methods still have certain limitations. Therefore, scholars should focus on exploring fusion genes, the clinical applications of molecular targets, and novel treatment methods. This study provides a strong reference for scholars in this field.
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Affiliation(s)
- Chang Song
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jia-Yuan Luo
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Yan Pang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Jiao Li
- Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun-Yan Zhao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Qu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Mei Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Yang
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bi-Qi Li
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Shi
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Balasubramanian JB, Choudhury PP, Mukhopadhyay S, Ahearn T, Chatterjee N, García-Closas M, Almeida JS. Wasm-iCARE: a portable and privacy-preserving web module to build, validate, and apply absolute risk models. ARXIV 2023:arXiv:2310.09252v1. [PMID: 37873020 PMCID: PMC10593073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objective Absolute risk models estimate an individual's future disease risk over a specified time interval. Applications utilizing server-side risk tooling, such as the R-based iCARE (R-iCARE), to build, validate, and apply absolute risk models, face serious limitations in portability and privacy due to their need for circulating user data in remote servers for operation. Our objective was to overcome these limitations. Materials and Methods We refactored R-iCARE into a Python package (Py-iCARE) then compiled it to WebAssembly (Wasm-iCARE): a portable web module, which operates entirely within the privacy of the user's device. Results We showcase the portability and privacy of Wasm-iCARE through two applications: for researchers to statistically validate risk models, and to deliver them to end-users. Both applications run entirely on the client-side, requiring no downloads or installations, and keeps user data on-device during risk calculation. Conclusions Wasm-iCARE fosters accessible and privacy-preserving risk tools, accelerating their validation and delivery.
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Affiliation(s)
| | - Parichoy Pal Choudhury
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- American Cancer Society, Atlanta, GA, USA
| | - Srijon Mukhopadhyay
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Thomas Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Montserrat García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- The Cancer Epidemiology and Prevention Research Unit, The Institute of Cancer Research, London, England
| | - Jonas S Almeida
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Jacob RA, Bade B, Joffe L, Makkar P, Alfano CM. The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 1. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:1-14. [PMID: 37359732 PMCID: PMC10043528 DOI: 10.1007/s40141-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
Abstract External beam ionizing radiation is a fundamental component of cancer treatment and is incorporated into approximately 50% of cancer treatments. Radiation therapy causes cell death directly by apoptosis and indirectly by disruption of mitosis. Purpose of Review This study aims to inform rehabilitation clinicians of the visceral toxicities of radiation fibrosis syndrome and how to detect and diagnose these complications. Recent Findings Latest research indicates that radiation toxicity is primarily related to radiation dose, patient co-morbidity, and concomitant use of chemotherapies and immunotherapies for the treatment of cancer. While cancer cells are the primary target, surrounding normal cells and tissues are also affected. Radiation toxicity is dose dependent, and tissue injury develops from inflammation that may progress to fibrosis. Thus, radiation dosing in cancer therapy is often limited by tissue toxicity. Although newer radiotherapeutic modalities aim to limit delivery of radiation to non-cancerous tissues, many patients continue to experience toxicity. Summary To ensure early recognition of radiation toxicity and fibrosis, it is imperative that all clinicians are aware of the predictors, signs, and symptoms of radiation fibrosis syndrome. Here, we present part 1 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the heart, lungs, and thyroid gland. Graphical abstract
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Wang Y, Kremer LCM, van Leeuwen FE, Armstrong GT, Leisenring W, de Vathaire F, Hudson MM, Kuehni CE, Arnold MA, Haddy N, Demoor-Goldschmidt C, Diallo I, Howell RM, Ehrhardt MJ, Moskowitz CS, Neglia JP, van der Pal HJH, Robison LL, Schaapveld M, Turcotte LM, Waespe N, Ronckers CM, Teepen JC. Cohort profile: Risk and risk factors for female breast cancer after treatment for childhood and adolescent cancer: an internationally pooled cohort. BMJ Open 2022; 12:e065910. [PMID: 36344003 PMCID: PMC9644351 DOI: 10.1136/bmjopen-2022-065910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The International Consortium for Pooled Studies on Subsequent Malignancies after Childhood and Adolescent Cancer was established in 2018 to address gaps in knowledge of risk and risk factors for breast cancer subsequent to childhood/adolescent cancer by pooling individual patient data from seven cohorts. Initially, the pooled cohort will focus on three clinically relevant questions regarding treatment-related subsequent breast cancer risk in female survivors, which are the risk related to low-dose radiotherapy exposure to the chest, specific chemotherapy agents and attained age. PARTICIPANTS The consortium database includes pooled data on 21 892 female survivors from seven cohorts in North America and Europe with a primary cancer diagnosis at <21 years of age, and survival ≥5 years from diagnosis. FINDINGS TO DATE This is a newly established pooled study. The cohort profile summarised the data collected from each included cohort, including childhood cancer diagnosis information and treatment details (ie, radiotherapy fields and cumulative doses, and chemotherapy agents and cumulative doses for each agent). Included cohorts' follow-up started 1951-1981 and ended 2013-2021, respectively, for a median follow-up duration of 24.3 (IQR 18.0-32.8) years since primary cancer diagnosis. The median age at primary cancer diagnosis was 5.4 (IQR 2.5-11.9) years. And the median attained age at last follow-up was 32.2 (IQR 24.0-40.4) years. In all, 4240 (19.4%) survivors were treated with radiotherapy to the chest and 9308 (42.5%) with anthracyclines. At the end of the follow-up, 835 females developed a first subsequent breast cancer, including 635 invasive breast cancer only, 184 carcinomas in situ only (172 ductal carcinomas in situ and 12 lobular carcinomas in situ), and 16 with both an invasive and in situ diagnosis at the same moment. The cumulative incidences of subsequent breast cancer (both invasive and in situ) 25 and 35 years after primary cancer diagnosis were 2.2% and 6.2%, respectively. FUTURE PLANS The consortium is intended to serve as a model and robust source of childhood/adolescent cancer survivor data for elucidating other knowledge gaps on subsequent breast cancer risk, and risk of other subsequent malignancies (including data on males) in the future.
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Affiliation(s)
- Yuehan Wang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nadia Haddy
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
- Department of Pediatric Hematology and Oncology, University-Hospital of Angers, Angers, France
- Radiotherapy department, Francois Baclesse center, Caen, France
- Supportive care department, Francois Baclesse center, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Villejuif, France
| | - Rebecca M Howell
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | | | | | | | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | - Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH research platform in pediatric oncology and hematology, University of Geneva, Geneva, Switzerland
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Man TK, Aubert G, Richard MA, LeJeune W, Hariri E, Goltsova T, Gaikwad A, Chen Y, Whitton J, Leisenring WM, Arnold MA, Neglia JP, Yasui Y, Robison LL, Armstrong GT, Bhatia S, Gramatges MM. Short NK and naïve T-cell telomere length is associated with thyroid cancer in childhood cancer survivors: A report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2021; 31:453-460. [PMID: 34782395 DOI: 10.1158/1055-9965.epi-21-0791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/04/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Survivors of childhood cancer are at risk for therapy-related subsequent malignant neoplasms (SMN), including thyroid SMN. Telomere length (TL) is associated with cancer risk, but the relationship between TL and SMN risk among survivors is less clear. METHODS We conducted a nested, matched case-control study of radiation-exposed 15-year+ adult survivors of childhood cancer with thyroid SMN (cases) and without SMN (controls). 46 cases were matched to 46 controls by primary diagnosis, chemotherapy (yes/no), radiation field, and follow-up duration. Lymphocyte TL (LTL) was measured by telomere flow-FISH cytometry using blood samples banked at a mean of 38.9 years (cases), 39.2 years (controls). Genetic variation in telomere genes was assessed by whole genome sequencing. Point estimates for LTL <10th percentile were determined for cases and controls. RESULTS Cases had shorter median LTL than controls in three out of four leukocyte subsets. Cases were more likely to have NK cell LTL <10th percentile (p=0.01), and 2.8-fold more likely to have naïve T-cell LTL <10th percentile than controls (CI 1.07, 8.78). Five out of 15 cases with a rare indel or missense variant had naïve T-cell LTL <10th percentile, compared with one out of 8 controls. CONCLUSIONS Long-term survivors have shorter than expected LTL, a finding that is more pronounced among survivors with thyroid SMN. IMPACT The long-term impact of childhood cancer treatment on immune function is poorly understood. Our findings support immune function studies in larger survivor cohorts to assess long-term deficits in adaptive and innate immunity that may underlie SMN risk.
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Affiliation(s)
- Tsz-Kwong Man
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Houston, Texas
| | - Geraldine Aubert
- British Columbia Cancer Agency, Vancouver, Canada
- Repeat Diagnostics, Inc., Vancouver, British Columbia, Canada
| | - Melissa A Richard
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Houston, Texas
| | - Wanda LeJeune
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Elmira Hariri
- Repeat Diagnostics, Inc., Vancouver, British Columbia, Canada
| | - Tatiana Goltsova
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Amos Gaikwad
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Yan Chen
- University of Alberta School of Public Health, Department of Public Health Sciences, Edmonton, Alberta, Canada
| | - Jillian Whitton
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Wendy M Leisenring
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Michael A Arnold
- University of Colorado School of Medicine, Department of Pathology, Aurora, Colorado
| | - Joseph P Neglia
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, Minnesota
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, Tennessee
| | - Leslie L Robison
- St. Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, Tennessee
| | - Gregory T Armstrong
- St. Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, Tennessee
| | - Smita Bhatia
- University of Alabama at Birmingham School of Medicine, Institute for Cancer Outcomes and Survivorship, Birmingham, Alabama
| | - Maria M Gramatges
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas.
- Dan L. Duncan Comprehensive Cancer Center, Houston, Texas
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8
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Song N, Liu Q, Wilson CL, Sapkota Y, Ehrhardt MJ, Gibson TM, Morton LM, Chanock SJ, Neglia JP, Arnold MA, Michael JR, Gout AM, Mulder HL, Easton J, Bhatia S, Armstrong GT, Zhang J, Delaney A, Hudson MM, Robison LL, Yasui Y, Wang Z. Polygenic Risk Score Improves Risk Stratification and Prediction of Subsequent Thyroid Cancer after Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:2096-2104. [PMID: 34465587 DOI: 10.1158/1055-9965.epi-21-0448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/05/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subsequent thyroid cancer (STC) is one of the most common malignancies in childhood cancer survivors. We aimed to evaluate the polygenic contributions to STC risk and potential utility in improving risk prediction. METHODS A polygenic risk score (PRS) was calculated from 12 independent SNPs associated with thyroid cancer risk in the general population. Associations between PRS and STC risk were evaluated among survivors from St. Jude Lifetime Cohort (SJLIFE) and were replicated in survivors from Childhood Cancer Survivor Study (CCSS). A risk prediction model integrating the PRS and clinical factors, initially developed in SJLIFE, and its performance were validated in CCSS. RESULTS Among 2,370 SJLIFE survivors with a median follow-up of 28.8 [interquartile range (IQR) = 21.9-36.1] years, 65 (2.7%) developed STC. Among them, the standardized PRS was associated with an increased rate of STC [relative rate (RR) = 1.57; 95% confidence interval (CI) = 1.24-1.98; P < 0.001]. Similar associations were replicated in 6,416 CCSS survivors, among whom 121 (1.9%) developed STC during median follow-up of 28.9 (IQR = 22.6-34.6) years (RR = 1.52; 95% CI = 1.25-1.83; P < 0.001). A risk prediction model integrating the PRS with clinical factors showed better performance than the model considering only clinical factors in SJLIFE (P = 0.004, AUC = 83.2% vs. 82.1%, at age 40), which was further validated in CCSS (P = 0.010, AUC = 72.9% vs. 70.6%). CONCLUSIONS Integration of the PRS with clinical factors provided a statistically significant improvement in risk prediction of STC, although the magnitude of improvement was modest. IMPACT PRS improves risk stratification and prediction of STC, suggesting its potential utility for optimizing screening strategies in survivorship care.
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Affiliation(s)
- Nan Song
- St. Jude Children's Research Hospital, Memphis, Tennessee.,College of Pharmacy, Chungbuk National University, Cheongju, Republic of South Korea
| | - Qi Liu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Yadav Sapkota
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | | | | | | | | | | | - John Easton
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jinghui Zhang
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela Delaney
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaoming Wang
- St. Jude Children's Research Hospital, Memphis, Tennessee.
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9
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Noyd DH, Neely NB, Schroeder KM, Lantos PM, Power S, Kreissman SG, Oeffinger KC. Integration of cancer registry and electronic health record data to construct a childhood cancer survivorship cohort, facilitate risk stratification for late effects, and assess appropriate follow-up care. Pediatr Blood Cancer 2021; 68:e29014. [PMID: 33742534 DOI: 10.1002/pbc.29014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This retrospective study harnessed an institutional cancer registry to construct a childhood cancer survivorship cohort, integrate electronic health record (EHR) and geospatial data to stratify survivors based on late-effect risk, analyze follow-up care patterns, and determine factors associated with suboptimal follow-up care. PROCEDURE The survivorship cohort included patients ≤18 years of age reported to the institutional cancer registry between January 1, 1994 and November 30, 2012. International Classification of Diseases for Oncology, third revision (ICD-O-3) coding and treatment exposures facilitated risk stratification of survivors. The EHR was linked to the cancer registry based on medical record number (MRN) to extract clinic visits. RESULTS Five hundred and ninety pediatric hematology-oncology (PHO) and 275 pediatric neuro-oncology (PNO) survivors were included in the final analytic cohort. Two hundred and eight-two survivors (32.6%) were not seen in any oncology-related subspecialty clinic at Duke 5-7 years after initial diagnosis. Factors associated with follow-up included age (p = .008), diagnosis (p < .001), race/ethnicity (p = .010), late-effect risk strata (p = .001), distance to treatment center (p < .0001), and area deprivation index (ADI) (p = .011). Multivariable logistic modeling attenuated the association for high-risk (OR 1.72; 95% CI 0.805, 3.66) and intermediate-risk (OR 1.23, 95% CI 0.644, 2.36) survivors compared to survivors at low risk of late effects among the PHO cohort. PNO survivors at high risk for late effects were more likely to follow up (adjusted OR 3.66; 95% CI 1.76, 7.61). CONCLUSIONS Nearly a third of survivors received suboptimal follow-up care. This study provides a reproducible model to integrate cancer registry and EHR data to construct risk-stratified survivorship cohorts to assess follow-up care.
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Affiliation(s)
- David H Noyd
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Kristin M Schroeder
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Paul M Lantos
- Departments of Internal Medicine, Pediatrics, and Community/Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steve Power
- Duke Cancer Institute, Durham, North Carolina, USA
| | - Susan G Kreissman
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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10
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Shin YE, Gail MH, Pfeiffer RM. Assessing risk model calibration with missing covariates. Biostatistics 2021; 23:875-890. [PMID: 33616159 DOI: 10.1093/biostatistics/kxaa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
When validating a risk model in an independent cohort, some predictors may be missing for some subjects. Missingness can be unplanned or by design, as in case-cohort or nested case-control studies, in which some covariates are measured only in subsampled subjects. Weighting methods and imputation are used to handle missing data. We propose methods to increase the efficiency of weighting to assess calibration of a risk model (i.e. bias in model predictions), which is quantified by the ratio of the number of observed events, $\mathcal{O}$, to expected events, $\mathcal{E}$, computed from the model. We adjust known inverse probability weights by incorporating auxiliary information available for all cohort members. We use survey calibration that requires the weighted sum of the auxiliary statistics in the complete data subset to equal their sum in the full cohort. We show that a pseudo-risk estimate that approximates the actual risk value but uses only variables available for the entire cohort is an excellent auxiliary statistic to estimate $\mathcal{E}$. We derive analytic variance formulas for $\mathcal{O}/\mathcal{E}$ with adjusted weights. In simulations, weight adjustment with pseudo-risk was much more efficient than inverse probability weighting and yielded consistent estimates even when the pseudo-risk was a poor approximation. Multiple imputation was often efficient but yielded biased estimates when the imputation model was misspecified. Using these methods, we assessed calibration of an absolute risk model for second primary thyroid cancer in an independent cohort.
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Affiliation(s)
- Yei Eun Shin
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Mitchell H Gail
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
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11
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Prasad PK, Mahajan P, Hawkins DS, Mostoufi-Moab S, Venkatramani R. Management of pediatric differentiated thyroid cancer: An overview for the pediatric oncologist. Pediatr Blood Cancer 2020; 67:e28141. [PMID: 32275118 DOI: 10.1002/pbc.28141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023]
Abstract
Differentiated thyroid cancer (DTC) is the most common childhood thyroid malignancy. The standard of care for pediatric DTC is total thyroidectomy followed by radioactive iodine (RAI) treatment when indicated. Molecular changes and potential therapeutic targets have been recently described in pediatric thyroid cancer. Pediatric oncologists are increasingly involved in the evaluation of thyroid nodules in childhood cancer survivors and in the management of advanced thyroid cancer. In 2015, the American Thyroid Association published management guidelines for children with DTC. We provide an overview of the current standard of care and highlight available targeted therapies for progressive or RAI refractory DTC.
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Affiliation(s)
- Pinki K Prasad
- Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Priya Mahajan
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Douglas S Hawkins
- Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Sogol Mostoufi-Moab
- Divisions of Endocrinology and Hematology/Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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12
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Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors. Support Care Cancer 2020; 28:5117-5124. [PMID: 32043175 DOI: 10.1007/s00520-020-05340-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/02/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Thyroid cancer is a common subsequent malignant neoplasm in childhood cancer survivors (CCS). Patients who received radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are considered to be at risk for subsequent thyroid cancer. Current Children's Oncology Group screening guidelines recommend annual neck palpation. Our objective was to determine if ultrasound (US) is more sensitive and specific than palpation to detect thyroid cancer in high-risk CCS and bone marrow transplant (BMT) survivors. METHODS Electronic medical records of patients followed in a longitudinal survivorship clinic from January 1, 2010 to December 31, 2017 were reviewed. Inclusion criteria included history of RT to the head, neck, upper thorax, or TBI for primary therapy or preparation for BMT prior to the age of 20 years. RESULTS Two hundred and twenty-five patients had documented palpation and 144 (64%) also had US evaluation. Mean radiation dose was 28.6 Gy. Sixteen of 225 patients (7.1%) developed a subsequent thyroid cancer at a mean of 9.7 years from the completion of RT. Sensitivity of US was 100% compared with 12.5% for palpation. US demonstrated higher accuracy, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.87 versus 0.56 for palpation (P < 0.0001). CONCLUSION Routine screening with US was more sensitive than palpation for detection of subsequent thyroid cancer after high-risk RT in CCS and BMT survivors. Screening US may lead to earlier detection of thyroid cancer in this population. Earlier diagnosis has the potential to decrease operative complexity, and earlier definitive therapy reduces the likelihood of metastatic disease.
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13
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Schonfeld SJ, Howell RM, Smith SA, Neglia JP, Turcotte LM, Arnold MA, Inskip PD, Oeffinger KC, Moskowitz CS, Henderson TO, Leisenring WM, Gibson TM, de González AB, Sampson JN, Chanock SJ, Tucker MA, Bhatia S, Robison LL, Armstrong GT, Morton LM. Comparison of Radiation Dose Reconstruction Methods to Investigate Late Adverse Effects of Radiotherapy for Childhood Cancer: A Report from the Childhood Cancer Survivor Study. Radiat Res 2020; 193:95-106. [PMID: 31794291 PMCID: PMC7063664 DOI: 10.1667/rr15308.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Quantification of radiation dose to normal tissue during radiotherapy is critical for assessing risk for radiotherapy-related late effects, including subsequent neoplasms (SNs). Case-control studies of SNs typically reconstruct absorbed radiation dose to the specific SN location using individual treatment parameters. A simplified method estimates the maximum prescribed target dose to the body region in which the SN arises. We compared doses and risk estimates from these methods using data from case-control studies of subsequent brain tumors (64 cases, 244 controls) and breast cancer (94 cases, 358 controls) nested within the Childhood Cancer Survivor Study (≥5-year survivors of childhood cancer diagnosed 1970-1986). The weighted kappa statistic [95% confidence interval (CI)] evaluating agreement between categorical (>0-9.9/10-19.9/20-29.9/≥30 Gy) body-region and tumor location-specific doses was 0.95 (0.91-0.98) for brain and 0.76 (0.69-0.82) for breast. The body-region and location-specific doses were assigned to the same dose category for a smaller proportion of patients treated with fields delivering a heterogeneous dose across the tissue of interest (e.g., partial brain field = 57.1%; mantle field = 61.3%) than patients treated with fields delivering a more homogeneous dose (e.g., whole brain field = 100%). Excess odds ratios per Gy (95% CI) from conditional logistic regression were 1.25 (0.33-6.33) and 1.20 (0.31-6.14) for brain tumors and 0.21 (0.05-0.77) and 0.10 (0.02-0.44) for breast cancer, using location-specific and body-region doses, respectively. We observed that body-region doses can approximate location-specific doses when the tissue of interest is clearly in the radiation field or outside the treated body region. Agreement is lower when there is greater ambiguity of SN location relative to the treatment field.
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Affiliation(s)
- Sara J. Schonfeld
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Susan A. Smith
- Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lucie M. Turcotte
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Peter D. Inskip
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Chaya S. Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Wendy M. Leisenring
- Clinical and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Todd M. Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Joshua N. Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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14
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Waguespack SG. Thyroid Sequelae of Pediatric Cancer Therapy. Horm Res Paediatr 2019; 91:104-117. [PMID: 30541010 DOI: 10.1159/000495040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
The hypothalamic-pituitary-thyroid axis is a common site of unintended, acquired disease either during or after the treatment of cancer. Children treated with external radiation therapy are at the highest risk for developing a thyroid-related late effect, but thyroid dysfunction and second primary thyroid neoplasms can also occur after treatment with radiopharmaceutical agents such as 131I-metaiodobenzylguanidine. Increasingly recognized is the development of early thyroid dysfunction as an off-target consequence of the more novel cancer therapeutics such as the tyrosine kinase inhibitors and immune checkpoint inhibitors. Thyroid sequelae resulting from irradiation may manifest only after years to decades of follow-up, and their resultant clinical symptoms may be indolent and non-specific. Therefore, lifelong monitoring of the childhood cancer survivor at risk for thyroid disease is paramount. In this comprehensive review, the myriad thyroid adverse effects resulting from pediatric cancer treatment are discussed and an overview of screening and treatment of these thyroid sequelae provided.
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Affiliation(s)
- Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and the Department of Pediatrics-Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
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15
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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16
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Alfano CM, Mayer DK, Bhatia S, Maher J, Scott JM, Nekhlyudov L, Merrill JK, Henderson TO. Implementing personalized pathways for cancer follow-up care in the United States: Proceedings from an American Cancer Society-American Society of Clinical Oncology summit. CA Cancer J Clin 2019; 69:234-247. [PMID: 30849190 PMCID: PMC7376887 DOI: 10.3322/caac.21558] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A new approach to cancer follow-up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow-up care pathways, depending on the type(s) and level(s) of resources needed for patients' long-term care, is in use in the United Kingdom and other countries and has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow-up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow-up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus-based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients' risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self-managing their health, setting expectations with patients from diagnosis onward for the need for follow-up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.
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Affiliation(s)
| | - Deborah K. Mayer
- Director of Cancer Survivorship and Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Smita Bhatia
- Director, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) School of Medicine, Professor and Vice Chair for Outcomes, Department of Pediatrics, UAB; and Associate Director for Cancer Outcomes Research, UAB Comprehensive Cancer Center, UAB, Birmingham, AL
| | - Jane Maher
- Joint Chief Medical Officer, Macmillan Cancer Support, London, United Kingdom
| | - Jessica M. Scott
- Principal Investigator, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larissa Nekhlyudov
- Associate Professor, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Janette K. Merrill
- Associate Director, Health Policy, American Society of Clinical Oncology, Alexandria, VA
| | - Tara O. Henderson
- Associate Professor, Department of Pediatrics, and Medical Director, Childhood Cancer Survivor Center, The University of Chicago Comer Children’s Hospital, Chicago, IL
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17
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Gramatges MM, Morton LM, Yasui Y, Arnold MA, Neglia JP, Leisenring WM, Machiela MJ, Dagnall CL, Chanock SJ, Armstrong GT, Robison LL, Bhatia S, Lupo PJ. Telomere Length-Associated Genetic Variants and the Risk of Thyroid Cancer in Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study (CCSS). Cancer Epidemiol Biomarkers Prev 2018; 28:417-419. [PMID: 30377209 DOI: 10.1158/1055-9965.epi-18-0972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the inverse relationship described previously between telomere content and thyroid subsequent malignant neoplasm (thyroid SMN) in survivors of childhood cancer, we investigated the relationship between known genetic determinants of leukocyte telomere length (LTL) and thyroid SMN among survivors. METHODS Leveraging data from a large, genotyped survivor cohort, the Childhood Cancer Survivor Study, we used a well-described genetic risk score method to estimate the HR for thyroid SMN among 5,324 genotyped survivors. RESULTS We identified 118 survivors with thyroid SMN and 5,206 without thyroid SMN. No association between genetically estimated LTL and risk for thyroid SMN was identified. CONCLUSIONS Our results suggest that variation in common SNPs influencing LTL is not strongly associated with risk for thyroid SMN in survivors of childhood cancer. IMPACT The previously observed inverse relationship between LTL and thyroid SMN risk in survivors of childhood cancer may be related to alternative molecular mechanisms and warrants further study.
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Affiliation(s)
- Maria M Gramatges
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Wendy M Leisenring
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Casey L Dagnall
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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18
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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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19
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Taddei PJ, Khater N, Youssef B, Howell RM, Jalbout W, Zhang R, Geara FB, Giebeler A, Mahajan A, Mirkovic D, Newhauser WD. Low- and middle-income countries can reduce risks of subsequent neoplasms by referring pediatric craniospinal cases to centralized proton treatment centers. Biomed Phys Eng Express 2018; 4:025029. [PMID: 30038799 PMCID: PMC6054490 DOI: 10.1088/2057-1976/aaa1ce] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Few children with cancer in low- and middle-income countries (LMICs) have access to proton therapy. Evidence exists to support replacing photon therapy with proton therapy to reduce the incidence of secondary malignant neoplasms (SMNs) in childhood cancer survivors. The purpose of this study was to estimate the potential reduction in SMN incidence and in SMN mortality for pediatric medulloblastoma patients in LMICs if proton therapy were made available to them. For nine children of ages 2 to 14 years, we calculated the equivalent dose in organs or tissues at risk for radiogenic SMNs from therapeutic and stray radiation for photon craniospinal irradiation (CSI) in a LMIC and proton CSI in a high-income country. We projected the lifetime risks of SMN incidence and SMN mortality for every SMN site with a widely-used model from the literature. We found that the average total lifetime attributable risks of incidence and mortality were very high for both photon CSI (168% and 41%, respectively) and proton CSI (88% and 26%, respectively). SMNs having the highest risk of mortality were lung cancer (16%), non-site-specific solid tumors (16%), colon cancer (5.9%), leukemia (5.4%), and for girls breast cancer (5.0%) after photon CSI and non-site-specific solid tumors (12%), lung cancer (11%), and leukemia (4.8%) after proton CSI. The risks were higher for younger children than for older children and higher for girls than for boys. The ratios of proton CSI to photon CSI of total risks of SMN incidence and mortality were 0.56 (95% CI, 0.37 to 0.75) and 0.64 (95% CI, 0.45 to 0.82), respectively, averaged over this sample group. In conclusion, proton therapy has the potential to lessen markedly subsequent SMNs and SMN fatalities in survivors of childhood medulloblastoma in LMICs, for example, through regional centralized care. Additional methods should be explored urgently to reduce therapeutic-field doses in organs and tissues at risk for SMN, especially in the lungs, colon, and breast tissues.
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Affiliation(s)
- Phillip J Taddei
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Nabil Khater
- Department of Radiation Oncology, Hôtel-Dieu de France Hospital, University of St. Joseph, P.O. Box 166830, Alfred Naccache Blvd, Beirut, Lebanon
| | - Bassem Youssef
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Rebecca M Howell
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wassim Jalbout
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Rui Zhang
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, 70803, USA
- Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, LA, 70809, USA
| | - Fady B. Geara
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Annelise Giebeler
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Anita Mahajan
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Dragan Mirkovic
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wayne D Newhauser
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, 70803, USA
- Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, LA, 70809, USA
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Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Cancer Treat Rev 2018; 63:28-39. [DOI: 10.1016/j.ctrv.2017.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 12/18/2022]
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21
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Mostoufi-Moab S, Labourier E, Sullivan L, LiVolsi V, Li Y, Xiao R, Beaudenon-Huibregtse S, Kazahaya K, Adzick NS, Baloch Z, Bauer AJ. Molecular Testing for Oncogenic Gene Alterations in Pediatric Thyroid Lesions. Thyroid 2018; 28:60-67. [PMID: 29108474 PMCID: PMC5770125 DOI: 10.1089/thy.2017.0059] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thyroid nodules are less common in pediatric patients (i.e., those ≤18 years) than they are in adults. The Bethesda System for Reporting Thyroid Cytopathology allows for individual risk stratification, but a significant number of nodules are indeterminate. Incorporating gene mutation panels and gene expression classifiers may aid in preoperative diagnosis. The overall aim of this study was to assess the prevalence of oncogene alterations in a representative pediatric population and across a broad-spectrum of thyroid tumor diagnoses. METHODS This was a retrospective cross-sectional evaluation of 115 archived samples, including: 47 benign (29 follicular adenoma, 11 diffuse hyperplasia, four thyroiditis, and three multinodular goiter), six follicular thyroid carcinomas (FTC), 24 follicular variant of papillary thyroid carcinomas (fvPTC), 27 classic variant of PTC (cPTC), eight diffuse sclerosing variant of PTC (dsvPTC), and three other PTC. Molecular testing was performed by multiplex qualitative polymerase chain reaction followed by bead array cytometry. Oncogene results were analyzed for association with age, sex, histology, lymph node metastasis, and intrathyroidal spread. RESULTS A mutation in one of the 17 molecular markers evaluated was found in: 2/6 (33%) FTC, 8/24 (33%) fvPTC, 17/27 (63%) cPTC, and 4/8 (50%) dsvPTC. Mutations in RAS or PAX8/PPARG were exclusive to FTC and fvPTC. BRAF was the most common mutation in cPTC (12/17; 71%), and RET/PTC was the only mutation associated with dsvPTC. Overall, a mutation was found in 32/68 (47%) malignant specimens, with a single follicular adenoma positive for PAX8/PPARG. The relative distribution of gene alterations in pediatric lesions was similar to adults. The presence of a BRAF mutation in pediatric cPTC did not predict a more invasive phenotype. CONCLUSIONS Of 33 nodules with genetic alterations, 32 were malignant. Mutations in RAS were most frequently associated with FTC, RET/PTC rearrangements with dsvPTC, and invasive fvPTC, and BRAF with cPTC. These results suggest a clinical role for mutational analysis of pediatric nodules to guide the surgical approach.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lisa Sullivan
- Division of Anatomic Pathology, Department of Pathology
| | - Virginia LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Department of Pediatric Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - N. Scott Adzick
- Division of General Surgery, Department of Pediatric Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Tonorezos ES, Barnea D, Moskowitz CS, Chou JF, Sklar CA, Elkin EB, Wong RJ, Li D, Tuttle RM, Korenstein D, Wolden SL, Oeffinger KC. Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation. J Cancer Surviv 2017; 11:302-308. [PMID: 28028762 PMCID: PMC5527324 DOI: 10.1007/s11764-016-0588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The optimal method of screening for thyroid cancer in survivors of childhood and young adult cancer exposed to neck radiation remains controversial. Outcome data for a physical exam-based screening approach are lacking. METHODS We conducted a retrospective review of adult survivors of childhood and young adult cancer with a history of neck radiation followed in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering between November 2005 and August 2014. Eligible patients underwent a physical exam of the thyroid and were followed for at least 1 year afterwards. Ineligible patients were those with prior diagnosis of benign or malignant thyroid nodules. RESULTS During a median follow-up of 3.1 years (range 0-9.4 years), 106 ultrasounds and 2277 physical exams were performed among 585 patients. Forty survivors had an abnormal thyroid physical exam median of 21 years from radiotherapy; 50% of those with an abnormal exam were survivors of Hodgkin lymphoma, 60% had radiation at ages 10-19, and 53% were female. Ultimately, 24 underwent fine needle aspiration (FNA). Surgery revealed papillary carcinoma in seven survivors; six are currently free of disease and one with active disease is undergoing watchful waiting. Among those with one or more annual visits, representing 1732 person-years of follow-up, no cases of thyroid cancer were diagnosed within a year of normal physical exam. CONCLUSIONS These findings support the application of annual physical exam without routine ultrasound for thyroid cancer screening among survivors with a history of neck radiation. IMPLICATIONS FOR CANCER SURVIVORS Survivors with a history of neck radiation may not require routine thyroid ultrasound for thyroid cancer screening. Among adult survivors of childhood and young adult cancer with a history of radiation therapy to the neck, annual physical exam is an acceptable thyroid cancer screening strategy.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dana Barnea
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne F Chou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena B Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Duan Li
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Thyroid neoplasms: incidental findings on extent of disease evaluation CT for other pediatric malignancies. J Pediatr Surg 2017; 52:938-943. [PMID: 28347527 PMCID: PMC5466891 DOI: 10.1016/j.jpedsurg.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE We performed a retrospective analysis to evaluate the risk of thyroid cancer in incidental thyroid nodules (ITNs) discovered on CT in patients with a history of pediatric cancer. METHODS With IRB approval we reviewed the records of pediatric oncology patients age ≤21y with newly detected thyroid nodules on surveillance CT of the neck, chest, chest/abdomen/pelvis, or PET/CT performed between April 2008 and March 2015. Patients with <6months of follow-up after incidental findings, a history of primary thyroid malignancy, or incomplete records were excluded. RESULTS The final cohort (N=68) included 35 females and 33 males (mean age 16.0±4.3[SD] years) with a mean follow-up time of 3.7±1.9[SD] years after CT detection of ITN(s). Twenty patients (29.4%) received a follow-up thyroid ultrasound, eleven (16.2%) of whom underwent fine needle aspiration (FNA) for cytopathologic diagnosis. Among these, six (8.8%) underwent thyroid resection, with final pathology demonstrating papillary carcinoma in five (7.4%) and benign pathology in one. CONCLUSIONS Despite the low incidence of thyroid nodules and low risk of thyroid malignancy in the general pediatric population, we found a significant rate of malignancy in CT-detected ITNs in our pediatric oncology patients, and recommend ultrasound and FNA of these nodules in this high-risk population. LEVEL OF EVIDENCE Level IV, retrospective study with no comparison group.
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Chargari C, Goodman KA, Diallo I, Guy JB, Rancoule C, Cosset JM, Deutsch E, Magne N. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models? Cancer Metastasis Rev 2017; 35:277-88. [PMID: 26970966 DOI: 10.1007/s10555-016-9616-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the era of modern radiation therapy, the compromise between the reductions in deterministic radiation-induced toxicities through highly conformal devices may be impacting the stochastic risk of second malignancies. We reviewed the clinical literature and evolving theoretical models evaluating the impact of intensity-modulated radiation therapy (IMRT) on the risk of second cancers, as a consequence of the increase in volumes of normal tissues receiving low doses. The risk increase (if any) is not as high as theoretical models have predicted in adults. Moreover, the increase in out-of-field radiation doses with IMRT could be counterbalanced by the decrease in volumes receiving high doses. Clinical studies with short follow-up have not corroborated the hypothesis that IMRT would drastically increase the incidence of second cancers. In children, the risk of radiation-induced carcinogenesis increases from low doses and consequently the relative risk of second cancers after IMRT could be higher than in adults, justifying current developments of proton therapy with priority given to this population. Although only longer follow-up will allow a true assessment of the real impact of these modern techniques on radiation-induced carcinogenesis, a comprehensive risk-adapted strategy will help minimize the probability of second cancers.
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Affiliation(s)
- Cyrus Chargari
- Radiotherapy Department, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.,INSERM 1030, Molecular Radiotherapy, Gustave Roussy campus Cancer, Grand Paris, France
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ibrahima Diallo
- U1018 Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Jean-Baptiste Guy
- Cellular and Molecular Radiotherapy Laboratory, EMR3738, 69921, Oullins, France.,Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Chloe Rancoule
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Jean-Marc Cosset
- Oncology/Radiotherapy Department, Institut Curie, 75005, Paris, France.,Charlebourg-La Défense Radiotherapy Center, Amethyst Group, La Garenne-Colombes, 92250, Paris, France
| | - Eric Deutsch
- INSERM 1030, Molecular Radiotherapy, Gustave Roussy campus Cancer, Grand Paris, France
| | - Nicolas Magne
- Cellular and Molecular Radiotherapy Laboratory, EMR3738, 69921, Oullins, France. .,Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France. .,Chef du Département de Radiothérapie, Directeur de la Recherche et de l'Innovation, Institut de Cancérologie Lucien Neuwirth, 108 bis, avenue Albert Raimond, BP 60008, 42270, Saint-Priest en Jarez cedex, France.
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Veiga LHS, Holmberg E, Anderson H, Pottern L, Sadetzki S, Adams MJ, Sakata R, Schneider AB, Inskip P, Bhatti P, Johansson R, Neta G, Shore R, de Vathaire F, Damber L, Kleinerman R, Hawkins MM, Tucker M, Lundell M, Lubin JH. Thyroid Cancer after Childhood Exposure to External Radiation: An Updated Pooled Analysis of 12 Studies. Radiat Res 2016; 185:473-84. [PMID: 27128740 DOI: 10.1667/rr14213.1] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Studies have causally linked external thyroid radiation exposure in childhood with thyroid cancer. In 1995, investigators conducted relative risk analyses of pooled data from seven epidemiologic studies. Doses were mostly <10 Gy, although childhood cancer therapies can result in thyroid doses >50 Gy. We pooled data from 12 studies of thyroid cancer patients who were exposed to radiation in childhood (ages <20 years), more than doubling the data, including 1,070 (927 exposed) thyroid cancers and 5.3 million (3.4 million exposed) person-years. Relative risks increased supralinearly through 2-4 Gy, leveled off between 10-30 Gy and declined thereafter, remaining significantly elevated above 50 Gy. There was a significant relative risk trend for doses <0.10 Gy (P < 0.01), with no departure from linearity (P = 0.36). We observed radiogenic effects for both papillary and nonpapillary tumors. Estimates of excess relative risk per Gy (ERR/Gy) were homogeneous by sex (P = 0.35) and number of radiation treatments (P = 0.84) and increased with decreasing age at the time of exposure. The ERR/Gy estimate was significant within ten years of radiation exposure, 2.76 (95% CI, 0.94-4.98), based on 42 exposed cases, and remained elevated 50 years and more after exposure. Finally, exposure to chemotherapy was significantly associated with thyroid cancer, with results supporting a nonsynergistic (additive) association with radiation.
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Affiliation(s)
- Lene H S Veiga
- a Divisions of Cancer Epidemiology and Genetics and.,c Institute for Radiation Protection and Dosimetry, Brazilian Nuclear Energy Commission, Rio de Janeiro, Brazil
| | - Erik Holmberg
- d Department of Oncology and Radiation Physics and the Oncological Centre, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Harald Anderson
- e Department of Cancer Epidemiology, Lund University, Lund, Sweden;,f Representing the Nordic Countries Childhood Cancer Survival Group
| | - Linda Pottern
- g Captain, United States Public Health Service (retired), Bethesda, Maryland
| | - Siegal Sadetzki
- h Cancer and Radiation Epidemiology Unit, The Gertner Institute, Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Jacob Adams
- i University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences, Rochester, New York
| | - Ritsu Sakata
- j Radiation Effects Research Foundation, Hiroshima, Japan (retired)
| | - Arthur B Schneider
- k University of Illinois College of Medicine, Section of Endocrinology, Diabetes and Metabolism, Chicago, Illinois
| | - Peter Inskip
- a Divisions of Cancer Epidemiology and Genetics and
| | - Parveen Bhatti
- l Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert Johansson
- m Oncology, Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gila Neta
- b Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, Bethesda, Maryland
| | - Roy Shore
- j Radiation Effects Research Foundation, Hiroshima, Japan (retired)
| | - Florent de Vathaire
- n Cancer Epidemiology Research Unit, National Institute for Health and Medical Research-Institut Gustave Roussy, Villejuif, France
| | - Lena Damber
- m Oncology, Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | | | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, University of Birmingham, Birmingham, United Kingdom; and
| | | | - Marie Lundell
- p Department of Medical Physics, Radiumhemmet, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Jay H Lubin
- a Divisions of Cancer Epidemiology and Genetics and
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Lau BJ, Goldfarb M. Age at Primary Malignancy Determines Survival in Adolescent and Young Adults That Develop a Secondary Thyroid Cancer. J Adolesc Young Adult Oncol 2016; 5:201-8. [PMID: 27042962 DOI: 10.1089/jayao.2015.0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Second malignancy status is a risk factor for death in adolescent and young adults (AYAs) (ages 15-39) with thyroid cancer (TC). This study investigates whether age at primary malignancy (PM) is an independent predictor of overall survival (OS) for AYA patients diagnosed with secondary TC who have survived ≥5 years from their PM. METHODS Surveillance, Epidemiology and End Results program (SEER) multiple-primary session (SEER-9 [1973-2010] and SEER-13 [1992-2010]) identified all secondary TCs in patients <40 years of age who were also 5-year survivors. Patients with a thyroid second malignant neoplasm (SMN) diagnosed as an AYA were categorized by age at PM (pediatric <15 years vs. AYA). Kaplan-Meier and Cox proportional analysis determined OS. RESULTS Four hundred twenty-eight cases of secondary AYA TCs in 5-year cancer survivors were identified; 71 had a pediatric PM and 357 an AYA PM. Median OS after a pediatric PM was 35.76 years and 33.22 years after an AYA-PM (p = 0.023); only one death was due to TC. Race, site and stage of PM, marital status, and three or more independent PMs also influenced OS (all p < 0.05). However, TC characteristics, stage, and treatment did not affect OS. Cox regression demonstrated that patients with an AYA PM had a 5.84 relative risk of death (95% confidence interval [95% CI]: 1.81-18.91) compared to patients with a pediatric PM. Among AYAs who develop a TC as a second PM, OS is not affected by the TC. The OS for these patients is associated with their demographics and the characteristics of their PM: patients who are black, male, have three or more primary cancers, and a higher stage of their first malignancy are more likely to die. CONCLUSION For AYA patients with thyroid SMNs, having a prior AYA PM (compared to a pediatric PM), Black race, and having three or more independent tumors predicted a decreased OS, independent of PM type or PM/SMN stage.
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Affiliation(s)
- Briana J Lau
- Department of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center , Santa Monica, California
| | - Melanie Goldfarb
- Department of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center , Santa Monica, California
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27
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Michel LA, Donckier J, Rosière A, Fervaille C, Lemaire J, Bertrand C. Post-Chernobyl incidence of papillary thyroid cancer among Belgian children less than 15 years of age in April 1986: a 30-year surgical experience. Acta Chir Belg 2016; 116:101-13. [PMID: 27385297 DOI: 10.1080/00015458.2016.1165528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We raised the question of a possible relationship in Belgium between the occurrence of papillary thyroid carcinoma (PTC) and age of children (<15 years) at the time of the Chernobyl nuclear plant accident in April 1986. SETTING Referral university centre for endocrine surgery. MATERIAL AND METHODS Thirty-year prospective study of the experience of a surgical team with PTC since the Chernobyl accident, taken out of 2349 patients operated on for any thyroid lesions from April 1986 to April 2015, comparing the incidence of PTC by age groups. MAIN OUTCOME MEASUREMENT Comparison of PTC incidence in patients >15 years (group A) and children <15 years (group B) in April 1986. RESULTS Out of a total of 2349 patients having undergone thyroid surgery for all types of lesions during 30 year after Chernobyl and born before April 1986, 2164 were >15 years of age at the time of the nuclear accident (group A) and 175 developed PTC (8.1%) compared to 36 PTC (19.5%) that occurred in 185 children <15 years of age (group B) in April 1986 (p < 0.001). CONCLUSIONS Radiation exposure affected residents of countries (including Belgium) well beyond Ukraine and Belarus. This was demonstrated by a 1990 meteorological report. Over 30 years, there has been a persistent higher incidence of PTC among Belgian children below the age of 15 years at the time of the Chernobyl accident. This relationship with age has even been strengthened by the implementation of more sophisticated immunohistochemical biomarkers diagnostic technology since April 2011.
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Comparison of Thyroid Nodule Prevalence by Ultrasound in Childhood Cancer Survivors With and Without Thyroid Radiation Exposure. J Pediatr Hematol Oncol 2016; 38:43-8. [PMID: 26583623 DOI: 10.1097/mph.0000000000000473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Children receiving radiotherapy of the head, neck, or chest as treatment of primary malignancies are at increased risk for secondary thyroid malignancy. We hypothesized that current standards (yearly thyroid physical examination) lead to a substantial number of missed thyroid nodules. Our objectives were: (1) use thyroid ultrasound to assess thyroid nodules in childhood cancer survivors; and (2) compare prevalence of thyroid nodules in thyroid radiation-exposed patients as compared with cancer survivors without radiation exposure. METHODS We recruited 60 patients with thyroid radiation and chemotherapy exposure (median age at cancer diagnosis 10.8 y) and 59 patients with chemotherapy exposure alone (median age at diagnosis 4.3 y) from our long-term survivorship clinics. Each patient had a thyroid physical examination and thyroid ultrasound performed. RESULTS Thirty-three patients (27.7%) had nodules >0.3 cm of which 2 were palpated (6.1%). We found 22 radiated patients (36.7%) with nodules versus 11 nonradiated patients (18.6%) (P=0.03). Eleven patients were biopsied and 1 diagnosis of secondary papillary thyroid carcinoma was confirmed. CONCLUSION Our study supports further examination of incorporating thyroid ultrasounds into long-term survivorship follow-up guidelines in radiation-exposed patients for the detection of thyroid nodules and secondary malignancies.
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29
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Martin OA, Yin X, Forrester HB, Sprung CN, Martin RF. Potential strategies to ameliorate risk of radiotherapy-induced second malignant neoplasms. Semin Cancer Biol 2015; 37-38:65-76. [PMID: 26721424 DOI: 10.1016/j.semcancer.2015.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/18/2022]
Abstract
This review is aimed at the issue of radiation-induced second malignant neoplasms (SMN), which has become an important problem with the increasing success of modern cancer radiotherapy (RT). It is imperative to avoid compromising the therapeutic ratio while addressing the challenge of SMN. The dilemma is illustrated by the role of reactive oxygen species in both the mechanisms of tumor cell kill and of radiation-induced carcinogenesis. We explore the literature focusing on three potential routes of amelioration to address this challenge. An obvious approach to avoiding compromise of the tumor response is the use of radioprotectors or mitigators that are selective for normal tissues. We also explore the opportunities to avoid protection of the tumor by topical/regional radioprotection of normal tissues, although this strategy limits the scope of protection. Finally, we explore the role of the bystander/abscopal phenomenon in radiation carcinogenesis, in association with the inflammatory response. Targeted and non-targeted effects of radiation are both linked to SMN through induction of DNA damage, genome instability and mutagenesis, but differences in the mechanisms and kinetics between targeted and non-targeted effects may provide opportunities to lessen SMN. The agents that could be employed to pursue each of these strategies are briefly reviewed. In many cases, the same agent has potential utility for more than one strategy. Although the parallel problem of chemotherapy-induced SMN shares common features, this review focuses on RT associated SMN. Also, we avoid the burgeoning literature on the endeavor to suppress cancer incidence by use of antioxidants and vitamins either as dietary strategies or supplementation.
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Affiliation(s)
- Olga A Martin
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia; Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Xiaoyu Yin
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia; Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia.
| | - Helen B Forrester
- Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular and Translational Sciences, Monash University, Clayton, VIC, Australia.
| | - Carl N Sprung
- Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular and Translational Sciences, Monash University, Clayton, VIC, Australia.
| | - Roger F Martin
- Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia.
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30
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Morton LM, Onel K, Curtis RE, Hungate EA, Armstrong GT. The rising incidence of second cancers: patterns of occurrence and identification of risk factors for children and adults. Am Soc Clin Oncol Educ Book 2015:e57-67. [PMID: 24857148 DOI: 10.14694/edbook_am.2014.34.e57] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As the population of cancer survivors has increased and continues to age, the occurrence of second cancers has risen dramatically-from 9% of all cancer diagnoses in 1975-1979 to 19% in 2005-2009. The Childhood Cancer Survivor Study, a cohort of more than 14,000 childhood cancer survivors with detailed exposure data and long-term follow-up, has substantially contributed to our understanding of the roles of radiotherapy and chemotherapy in second cancer occurrence. In particular, dose-related risks have been demonstrated for second cancers of the breast, thyroid, central nervous system, gastrointestinal tract, and sarcomas following radiation. Cytotoxic chemotherapy-which has long been known to be leukemogenic-also appears to contribute to risk for a range of other second cancer types. Individuals who develop a second cancer are at particularly high risk for developing additional second cancers. A genome-wide association study of survivors of Hodgkin lymphoma who received radiotherapy identified a locus on chromosome 6q21 as being associated with second cancer risk, demonstrating that recent advances in genomics are likely to prove invaluable for elucidating the contribution of genetic susceptibility to second cancer etiology. Among adults, risk of second cancers varies substantially by type of first and second cancer, patient age, and prevalence of second cancer risk factors, including primary cancer treatments, environmental and lifestyle exposures, and genetic susceptibility. Further research is needed to quantify second cancer risks associated with specific etiologic factors and to identify the patients at highest risk of developing a second cancer to target prevention and screening efforts.
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Affiliation(s)
- Lindsay M Morton
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; Department of Pediatrics, The University of Chicago, Chicago, IL; and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Kenan Onel
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; Department of Pediatrics, The University of Chicago, Chicago, IL; and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Rochelle E Curtis
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; Department of Pediatrics, The University of Chicago, Chicago, IL; and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Eric A Hungate
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; Department of Pediatrics, The University of Chicago, Chicago, IL; and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; Department of Pediatrics, The University of Chicago, Chicago, IL; and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Lollert A, Gies C, Laudemann K, Faber J, Jacob-Heutmann D, König J, Düber C, Staatz G. Ultrasound Evaluation of Thyroid Gland Pathologies After Radiation Therapy and Chemotherapy to Treat Malignancy During Childhood. Int J Radiat Oncol Biol Phys 2015; 94:139-146. [PMID: 26545453 DOI: 10.1016/j.ijrobp.2015.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate correlations between treatment of malignancy by radiation therapy during childhood and the occurrence of thyroid gland pathologies detected by ultrasonography in follow-up examinations. METHODS AND MATERIALS Reductions of thyroid gland volume below 2 standard deviations of the weight-specific mean value, occurrence of ultrasonographically detectable thyroid gland pathologies, and hypothyroidism were retrospectively assessed in 103 children and adolescents 7 months to 20 years of age (median: 7 years of age) at baseline (1997-2013) treated with chemoradiation therapy (with the thyroid gland dose assessable) or with chemotherapy alone and followed by ultrasonography and laboratory examinations through 2014 (median follow-up time: 48 months). RESULTS A relevant reduction of thyroid gland volume was significantly correlated with thyroid gland dose in univariate (P<.001) and multivariate analyses for doses above 2 Gy. Odds ratios were 3.1 (95% confidence interval: 1.02-9.2; P=.046) for medium doses (2-25 Gy) and 14.8 (95% confidence interval: 1.4-160; P=.027) for high doses (>25 Gy). Thyroid gland dose was significantly higher in patients with thyroid gland pathologies during follow-up (P=.03). Univariate analysis revealed significant correlations between hypothyroidism and thyroid gland dose (P<.001). CONCLUSIONS Ultrasonographically detectable changes, that is, volume reductions, pathologies, and hypothyroidism, after malignancy treatment during childhood are associated with thyroid gland dose. Both ultrasonography and laboratory follow-up examinations should be performed regularly after tumor therapy during childhood, especially if the treatment included radiation therapy.
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Affiliation(s)
- André Lollert
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Christina Gies
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Laudemann
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörg Faber
- Department of Pediatrics and Adolescent Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dorothee Jacob-Heutmann
- Department of Radio-oncology and Radiotherapy, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jochem König
- Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Thomas-Teinturier C, Salenave S. Séquelles endocriniennes après traitement d’un cancer pédiatrique : de l’enfance à l’âge adulte. Bull Cancer 2015; 102:612-21. [DOI: 10.1016/j.bulcan.2015.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Salz T, Baxi SS, Raghunathan N, Onstad EE, Freedman AN, Moskowitz CS, Dalton SO, Goodman KA, Johansen C, Matasar MJ, de Nully Brown P, Oeffinger KC, Vickers AJ. Are we ready to predict late effects? A systematic review of clinically useful prediction models. Eur J Cancer 2015; 51:758-66. [PMID: 25736818 DOI: 10.1016/j.ejca.2015.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. PURPOSE To identify and describe all models that predict the risk of late effects and could be used in clinical practice. DATA SOURCES We searched Medline through April 2014. STUDY SELECTION Studies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting. DATA EXTRACTION Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation. DATA SYNTHESIS Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. CONCLUSION Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - Shrujal S Baxi
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Erin E Onstad
- Harvard School of Public Health, Boston, MA, United States
| | | | | | | | - Karyn A Goodman
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | | | | | | | - Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
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35
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Tonorezos ES, Henderson TO. Clinical Guidelines for the Care of Childhood Cancer Survivors. CHILDREN-BASEL 2014; 1:227-40. [PMID: 27417477 PMCID: PMC4928728 DOI: 10.3390/children1020227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 12/13/2022]
Abstract
The Long-Term Follow-Up Guidelines for survivors of childhood, adolescent, and young adult cancers are evidence- and consensus-based guidelines that have been developed and published by the Children's Oncology Group (COG) Late Effects Committee, Nursing Discipline, and the Patient Advocacy Committee. Originally published in 2004, the guidelines are currently in version 3.0. While the COG guidelines have been praised as a model for providing risk-based survivorship care, adherence has not been uniform. Reasons for this gap include unawareness on the part of the survivor and/or care team as well as disagreement about the individual recommendations. In some cases, the burden of testing (such as annual echocardiography or repeat pulmonary function testing) may be too great. A small number of intervention studies have documented improved adherence to guideline recommendations with dissemination of informational material. Future studies should focus on individualizing screening recommendations, as well as identifying unnecessary testing.
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Affiliation(s)
- Emily S Tonorezos
- Departments of Medicine, Memorial Sloan Kettering and Weill Cornell Medical College, 300 East 66th Street, New York, NY 10065, USA.
| | - Tara O Henderson
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Avenue, MC 4060, Chicago, IL 60637, USA.
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Moskowitz CS, Oeffinger KC. Predicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer. CHILDREN (BASEL, SWITZERLAND) 2014; 1:63-73. [PMID: 26236650 PMCID: PMC4521414 DOI: 10.3390/children1020063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
More than 80% of children and young adults diagnosed with invasive cancer will survive five or more years beyond their cancer diagnosis. This population has an increased risk for serious illness- and treatment-related morbidity and premature mortality. A number of these adverse health outcomes, such as cardiovascular disease and some second primary neoplasms, either have modifiable risk factors or can be successfully treated if detected early. Absolute risk models that project a personalized risk of developing a health outcome can be useful in patient counseling, in designing intervention studies, in forming prevention strategies, and in deciding upon surveillance programs. Here, we review existing absolute risk prediction models that are directly applicable to survivors of a childhood cancer, discuss the concepts and interpretation of absolute risk models, and examine ways in which these models can be used applied in clinical practice and public health.
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Affiliation(s)
- Chaya S. Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 307 E 63rd Street, New York, NY 10065, USA
| | - Kevin C. Oeffinger
- Departments of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, 9th Floor, New York, NY 10065, USA; E-Mail:
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Michaelson EM, Chen YH, Silver B, Tishler RB, Marcus KJ, Stevenson MA, Ng AK. Thyroid Malignancies in Survivors of Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2014; 88:636-41. [DOI: 10.1016/j.ijrobp.2013.11.237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/16/2013] [Accepted: 11/19/2013] [Indexed: 01/09/2023]
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Goldfarb M, Freyer DR. Comparison of secondary and primary thyroid cancer in adolescents and young adults. Cancer 2014; 120:1155-61. [PMID: 24615715 DOI: 10.1002/cncr.28463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/03/2013] [Accepted: 09/30/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Thyroid cancer is one of the 5 most common malignancies in adolescent and young adult (AYA) patients (ages 15-39 years) and may develop de novo or in patients previously treated for cancer. This study compared the tumor characteristics, treatment, and overall survival (OS) of secondary malignant neoplasm (SMN) versus primary thyroid cancer in AYA patients. METHODS All cases of AYA thyroid cancer contained in the 1998 to 2010 American College of Surgeons National Cancer Database were divided into 2 cohorts according to primary or secondary occurrence. Comparisons using appropriate statistical methods were performed. RESULTS Of 41,062 cases, 1349 (3.3%) had experienced a prior malignancy. Compared with cases of primary thyroid cancer, SMNs were more likely multifocal (odds ratio [OR] = 1.173, 95% confidence interval [CI] = 1.049-1.313) microcarcinomas < 1 cm (OR = 1.496, 95% CI = 1.327-1.687) with tall/columnar cells (OR = 2.187, 95% CI = 0.534-0.692), of white race (OR = 2.643, 95% CI = 1.310-5.331) and age 35-39 years (OR = 1.239, 95% CI = 1.093-1.404) and less likely female (OR = 0.608, 95% CI = 0.534-0.692), Hispanic (OR = 0.779, 95% CI = 0.642-0.946) age 15-19 years (OR = 0.624, 95% CI = 0.510-0.763) or 25-29 years (OR = 0.711, 95% CI = 0.604-0.837), or less likely > 4 cm in size (OR = 0.610, 95% CI = 0.493-0.758). There was a 6.63-fold (95% CI = 4.97-8.86, P < .001) relative risk of death for secondary versus primary thyroid cancers after adjusting for demographic, tumor, and thyroid treatment factors. Only Hispanic origin, tall/columnar cell histology, and distant metastases decreased OS for SMNs. CONCLUSIONS AYAs who develop thyroid cancer as a SMN have a significantly decreased OS compared to AYAs with primary thyroid cancer. Multiple demographic and tumor differences exist between these 2 cohorts. Whether the outcome disparity results from previous cancer treatment or differences in biology, environment, or access to care are areas needing further investigation.
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Affiliation(s)
- Melanie Goldfarb
- University of Southern California Keck School of Medicine, Los Angeles, California
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Oeffinger KC, Baxi SS, Novetsky Friedman D, Moskowitz CS. Solid tumor second primary neoplasms: who is at risk, what can we do? Semin Oncol 2014; 40:676-89. [PMID: 24331190 DOI: 10.1053/j.seminoncol.2013.09.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Eighteen percent of incident malignancies in the United States are a second (or subsequent) cancer. Second primary neoplasms (SPNs), particularly solid tumors, are a major cause of mortality and serious morbidity among cancer survivors successfully cured of their first cancer. Multiple etiologies may lead to a cancer survivor subsequently being diagnosed with an SPN, including radiotherapy for the first cancer, unhealthy lifestyle behaviors, genetic factors, aging, or an interaction between any of these factors. In this article, we discuss these factors and synthesize this information for use in clinical practice, including preventive strategies and screening recommendations for SPNs.
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Affiliation(s)
- Kevin C Oeffinger
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Shrujal S Baxi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Chaya S Moskowitz
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
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Chemaitilly W, Hudson MM. Update on endocrine and metabolic therapy-related late effects observed in survivors of childhood neoplasia. Curr Opin Endocrinol Diabetes Obes 2014; 21:71-6. [PMID: 24275618 DOI: 10.1097/med.0000000000000029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW To provide a summary of the most recent research pertaining to the endocrine and metabolic complications observed in childhood cancer survivors. RECENT FINDINGS Data on prevalence and risk associations are increasingly available from large cohorts of childhood cancer survivors. New directions in research include novel risk-prediction strategies and the study of genetic predisposition. SUMMARY Endocrine complications are observed in more than 50% of adult childhood cancer survivors. Some continue to develop decades following cancer treatment exposures. The present review provides a summary of the most recent outcomes research pertaining to growth, thyroid, gonadal-reproductive, bone and body composition with emphasis on new directions and challenges in each area.
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Affiliation(s)
- Wassim Chemaitilly
- aDepartment of Pediatric Medicine - Division of Endocrinology bDepartment of Epidemiology and Cancer Control cDepartment of Oncology-Division of Survivorship3, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Barnes N, Chemaitilly W. Endocrinopathies in survivors of childhood neoplasia. Front Pediatr 2014; 2:101. [PMID: 25295241 PMCID: PMC4172013 DOI: 10.3389/fped.2014.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023] Open
Abstract
Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.
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Affiliation(s)
- Nicole Barnes
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA ; Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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42
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Wein RO. Acquired disorders of the thyroid following treatment for head and neck cancer. Expert Rev Endocrinol Metab 2013; 8:461-467. [PMID: 30754189 DOI: 10.1586/17446651.2013.827396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The multimodality management of head and neck cancer routinely utilizes radiation therapy in treatment. The hypothalamus, pituitary and thyroid gland may be included within treatment fields. The incidence of human papilloma virus-associated oropharyngeal carcinoma has seen a dramatic increase over the last 3 decades. Current guidelines for the long-term aftercare assessment advocate only for thyroid-stimulating hormone levels every 6-12 months after baseline posttreatment imaging. With a growing population of younger patients with a favorable prognosis exposed to therapeutic radiation therapy, it is anticipated that incidence of thyroid-associated complications, such as hypothyroidism and thyroid cancer, could increase significantly over time. Constructing a strategy for the long-term reassessment of these patients beyond existing guidelines may be necessary.
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Affiliation(s)
- Richard O Wein
- a Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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