Risk of thyroid dysfunction and subsequent thyroid cancer among survivors of acute lymphoblastic leukemia: A report from the childhood cancer survivor study Journal Article


Authors: Chow, E. J.; Friedman, D. L.; Stovall, M.; Yasui, Y.; Whitton, J. A.; Robison, L. L.; Sklar, C. A.
Article Title: Risk of thyroid dysfunction and subsequent thyroid cancer among survivors of acute lymphoblastic leukemia: A report from the childhood cancer survivor study
Abstract: Background. To determine the risk of thyroid dysfunction and subsequent thyroid cancer among childhood acute lymphoblastic leukemia (ALL) survivors. Procedure. Rates of self-reported thyroid dysfunction and thyroid cancer were determined among 3,579 ALL survivors participating in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of pediatric cancers diagnosed from 1970 to 1986, and compared with 3,846 siblings and population rates, respectively. Results. The cumulative incidence of hypo- and hyperthyroidism among survivors 15 years following leukemia diagnosis was 1.6% (95% CI 1.1, 2.1) and 0.6% (95% CI 0.3, 1.1), respectively, both significantly increased compared with siblings. In multivariate analysis, survivors who received ≥20 Gy cranial radiotherapy plus any spinal radiotherapy had the highest risk of subsequent hypothyroidism (HR 8.3, 95% CI 3.3, 20.5) compared with those treated with chemotherapy alone. Craniospinal radio-therapy also was associated with an increased risk of subsequent hyperthyroidism (HR 6.1, 95% CI 1.1, 34.2) compared with chemotherapy alone, as well as an increased risk of subsequent thyroid cancers (SIR 30.3, 95% CI 14.5, 55.7) compared with population rates. In radiation dosimetry analysis, pituitary doses ≥20 Gy combined with thyroid doses ≥10 Gy were associated with hypothyroidism, whereas pituitary doses ≥20 Gy combined with thyroid doses ≥15 Gy were associated with hyperthyroidism. Conclusions. The risk of thyroid dysfunction and thyroid cancer was increased among childhood ALL survivors treated with craniospinal radiotherapy. In these individuals, long-term surveillance is warranted as no obvious plateau in risk was seen, even after 25 years of follow-up. © 2009 Wiley-Liss, Inc.
Keywords: adolescent; adult; cancer chemotherapy; child; controlled study; preschool child; school child; child, preschool; leukemia; major clinical study; cancer risk; cancer radiotherapy; radiation dose; antineoplastic agent; cancer diagnosis; radiation; cohort analysis; risk factors; acute lymphoblastic leukemia; skull irradiation; late effects; cancer survivor; risk assessment; self report; survivors; infant; infant, newborn; dosimetry; precursor cell lymphoblastic leukemia-lymphoma; thyroid cancer; thyroid neoplasms; hyperthyroidism; hypothyroidism; sibling; thyroid diseases
Journal Title: Pediatric Blood and Cancer
Volume: 53
Issue: 3
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2009-01-01
Start Page: 432
End Page: 437
Language: English
DOI: 10.1002/pbc.22082
PUBMED: 19459201
PROVIDER: scopus
PMCID: PMC2713362
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 30 November 2010" - "CODEN: PBCEA" - "Source: Scopus"
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  1. Charles A Sklar
    312 Sklar