Thyroid function in paediatric and young adult patients after sarcoma therapy: a report from the Late Effects Surveillance System.
OBJECTIVE
The role of chemotherapy in thyroid sequelae after cancer treatment has not been studied systematically, especially in sarcoma patients. The aim of this study was to determine the incidence of post-therapeutic thyroid disorders and their contributing factors in a cohort of paediatric sarcoma patients.


METHODS
Late effects of sarcoma treatment have been collected prospectively within the Late Effects Surveillance System (LESS) in Germany, Austria and Switzerland since 1998.


METHODS
We studied 340 relapse-free paediatric patients (median age at diagnosis 12.2 [interquartile range (IQR) = 7.3-15.6 years] treated for osteosarcoma, soft tissue sarcoma or Ewing's sarcoma within the COSS-96, CWS-96/CWS-2002P or EICESS-92/EURO-E.W.I.N.G.-99 therapy trials. In addition to polychemotherapy, 127 patients were irradiated (mean cumulative dose 47 +/- 9.7 Gy), including 51 patients with irradiation to the head/neck region. Median follow-up was 24.6 (IQR = 11.9-44.9) months.


METHODS
We reviewed the results of yearly examinations of serum TSH and fT4 levels and thyroid ultrasound examinations.


RESULTS
The incidence of thyroid disorders was 37% (19/51, 95% CI 24-52%) in patients with head/neck irradiation, and 11% (32/289, 95% CI 8-15%) in patients without irradiation to the head/neck. Thyroid disorders were more frequent in patients treated with idarubicin (P = 0.027) and trofosfamide (P = 0.016). We also found a significant association between raised TSH levels and treatment with trofosfamide (P = 0.008) or idarubicin (P = 0.037) (n = 250).


CONCLUSIONS
The incidence of thyroid disorders in the head/neck-irradiated group was high. Even without head/neck irradiation, we found an increased proportion of patients with thyroid disorders, possibly as a result of chemotherapy.
Paulides
M
M
LESS Study Center, University Hospital for Children and Adolescents, Erlangen, Germany.
Dörr
H G
HG
Stöhr
W
W
Bielack
S
S
Koscielniak
E
E
Klingebiel
T
T
Jürgens
H
H
Bölling
T
T
Willich
N
N
Sauer
R
R
Langer
T
T
Beck
J D
JD
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D003520:Cyclophosphamide / Q000009:adverse effects / Q000031:analogs & derivatives; D003609:Dactinomycin / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D012509:Sarcoma / Q000150:complications / Q000628:therapy*; D013959:Thyroid Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000187:drug effects / Q000503:physiopathology* / Q000528:radiation effects; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use; D014750:Vincristine / Q000009:adverse effects
D003609:Dactinomycin; D014750:Vincristine; D003520:Cyclophosphamide; D013972:Thyrotropin; C003726:trofosfamide; D013974:Thyroxine; D007069:Ifosfamide