title: Thyroid adenomas and carcinomas following radiotherapy for a hemangioma during infancy.
abstract: OBJECTIVE
  A cohort study was performed to investigate the carcinogenic effect of treating skin hemangioma with ionizing radiation during early childhood. This paper presents the incidence of differentiated thyroid adenomas and carcinomas after radiotherapy in this cohort.
  
  
  METHODS
  Of a total of 8307 patients treated for a skin hemangioma between 1940 and 1973 at the Institut Gustave-Roussy, 4767 were included in an incidence study, among whom 3795 had received radiotherapy. Seventy-three percent were less than 1-year-old at the time of treatment. External radiotherapy, Radium 226, Strontium 90, Yttrium 90, and Phosphorus 32 were used. The radiation dose received by the thyroid during radiotherapy, estimated in 3497 of the 3795 patients using specific software, was 41 mGy on average. Thyroid tumor cases were obtained by sending out a questionnaire, and were verified in pathological reports. Estimates of thyroid cancer specific incidence rates in the French population were obtained from the French cancer registry network. External and internal analyses were performed.
  
  
  RESULTS
  During an average follow-up of 35 years, 11 patients developed a differentiated thyroid carcinoma and 44 a thyroid adenoma. The incidence of thyroid adenoma was found to be higher among taller and heavier individuals. The incidence of both thyroid carcinoma and adenoma was higher among non-smoker patients. A significant dose-response relationship was found between the radiation dose received by thyroid and the risk of thyroid cancer (Excess Relative Risk per GY, ERR/Gy: 14.7, 95%CI: 1.6-62.9) and of adenoma (ERR/Gy: 5.7, 95%CI: 0.7-19.4).
  
  
  CONCLUSIONS
  This study confirms that radiation treatment performed in the past for hemangioma during infancy increased the risk of thyroid carcinoma and adenoma. Patients treated with external radiotherapy or with Radium 226 applicators for hemangiomas have to be more specifically followed up because this is the subgroup in whom the highest doses were received by the thyroid gland (more than 90% of the radiation doses were higher than 100 mGy). They are therefore more at risk of developing thyroid cancer.
authors.affiliation: Inserm, U605, Villejuif, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Haddy
authors.forename: Tianarimanana
authors.initials: T
authors.lastname: Andriamboavonjy
authors.forename: Catherine
authors.initials: C
authors.lastname: Paoletti
authors.forename: Marie-Gabrielle
authors.initials: MG
authors.lastname: Dondon
authors.forename: Abdeddahir
authors.initials: A
authors.lastname: Mousannif
authors.forename: Akhtar
authors.initials: A
authors.lastname: Shamsaldin
authors.forename: Françoise
authors.initials: F
authors.lastname: Doyon
authors.forename: Martine
authors.initials: M
authors.lastname: Labbé
authors.forename: Caroline
authors.initials: C
authors.lastname: Robert
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Avril
authors.forename: Philippe
authors.initials: P
authors.lastname: Fragu
authors.forename: François
authors.initials: F
authors.lastname: Eschwege
authors.forename: Jean
authors.initials: J
authors.lastname: Chavaudra
authors.forename: Claire
authors.initials: C
authors.lastname: Schvartz
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006391:Hemangioma / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D011883:Radium / Q000009:adverse effects; D013964:Thyroid Neoplasms / Q000209:etiology*
chemical_list: D011883:Radium