Thyroid radiation dose and other risk factors of thyroid carcinoma following childhood cancer.
Fiche publication
Date publication
septembre 2015
Auteurs
Membres identifiés du Cancéropôle Est :
Dr MUNZER Martine
Tous les auteurs :
de Vathaire F, Haddy N, Allodji R, Hawkins M, Guibout C, El-Fayech C, Teinturier C, Oberlin O, Pacquement H, Diop F, Kalhouche A, Benadjaoud M, Winter D, Jackson A, Bezin Mai-Quynh G, Benabdennebi A, Llanas D, Veres C, Munzer M, Dat Nguyen T, Bondiau PY, Berchery D, Laprie A, Deutsch E, Lefkopoulos D, Schlumberger M, Diallo I, Rubino C
Lien Pubmed
Résumé
CONTEXT: Thyroid carcinoma is a frequent complication of childhood cancer radiotherapy. The dose-response to thyroid radiation dose is now well established, but the potential modifier effect of other factors still requires further investigation. OBJECTIVES: To investigate the role of potential modifiers of the dose-response. DESIGN: We followed, over an average of 27 years, a cohort of 4338 5-year survivors of solid childhood cancer treated before 1986. The dose received by the thyroid gland and some other anatomical sites during radiotherapy was estimated after reconstruction of the actual conditions in which irradiation was delivered. RESULTS: Fifty-five (55) patients developed a thyroid carcinoma. The risk of thyroid carcinoma increased with a radiation dose to the thyroid of up to two tenths of Gy, then leveled off for higher doses. When taking into account the thyroid radiation dose, a surgical or radiological splenectomy (>20 Gy to the spleen) increased thyroid cancer risk (RR=2.3, 95%CI:1.3-4.0), high radiation doses (> 5 Gy) to pituitary gland lowered this risk (RR=0.2, 95%CI:0.1-0.6). Patients who received nitrosourea chemotherapy had a 6.6-fold (95%CI: 2.5-15.7) higher risk than those who did not. The excess relative risk per Gy of radiation to the thyroid was 4.7 (95%CI: 1.7 to 22.6). It was 7.6 (95%CI: 1.6 to 33.3) if body mass index at time of interview was equal or higher than 25, and 4.1 (95%CI: 0.9-17.7) if not (p-value for interaction=0.1). CONCLUSION: Predicting thyroid cancer risk following childhood cancer radiation therapy probably requires the assessment of more than just the radiation dose to the thyroid. Chemotherapy, splenectomy, radiation dose to pituitary gland, and obesity also play a role.
Référence
J Clin Endocrinol Metab. 2015 Sep 1:jc20151690.