No damaging effect of chemotherapy in addition to radiotherapy on the thyroid axis in young adult survivors of childhood cancer.
Late effects of treatment for childhood cancer on the thyroid axis are ascribed predominantly to radiotherapy. Whether chemotherapy has an additional detrimental effect is still unclear. Our aim was to evaluate this effect in young adult survivors of a broad spectrum of childhood cancers. The thyroid axis in 205 childhood cancer survivors was evaluated in relation to former use of chemotherapy and radiotherapy (cranial, cranio-spinal, cervical, mediastinal, or thoracic). The mean follow-up time was 17.5 yr. Damage to the thyroid axis was found in 55 patients (26.8%). Thirty-seven patients (18%) had thyroidal disease. Diagnoses varied from TSH elevation to papillary carcinoma. After multivariate analysis, high risk radiation field, irradiation dose, and the diagnosis of non-Hodgkin lymphoma/Hodgkin's disease were found to be significant risk factors for developing thyroid disease. Treatment with chemotherapy did not have an additional negative effect on the thyroid axis. For the development of central (pituitary or hypothalamic) thyroid dysfunction, patients with a brain tumor were at increased risk. Chemotherapy for childhood cancer does not contribute to the damage on the thyroid axis inflicted by radiotherapy during young adulthood.
van Santen
Hanneke M
HM
Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands.
Vulsma
Thomas
T
Dijkgraaf
Marcel G
MG
Blumer
Regje M E
RM
Heinen
Richard
R
Jaspers
Monique W M
MW
Geenen
Maud M
MM
Offringa
Martin O
MO
de Vijlder
Jan J M
JJ
van den Bos
Cor
C
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D017741:Survivors; D013959:Thyroid Diseases / Q000453:epidemiology / Q000209:etiology; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000187:drug effects / Q000502:physiology* / Q000528:radiation effects; D013963:Thyroid Hormones / Q000097:blood
D000970:Antineoplastic Agents; D013963:Thyroid Hormones