Thyroid Ultrasound Screening in Childhood Cancer Survivors following Radiotherapy

Julia A Baran; Stephen Halada; Andrew J Bauer; Yimei Li; Amber Isaza; Tasleema Patel; Lindsay Sisko; Jill P Ginsberg; Ken Kazahaya; N Scott Adzick; Sogol Mostoufi-Moab

doi:10.1159/000531241

Thyroid Ultrasound Screening in Childhood Cancer Survivors following Radiotherapy

Horm Res Paediatr. 2023 Sep 18:1-11. doi: 10.1159/000531241. Online ahead of print.

Authors

Julia A Baran¹, Stephen Halada², Andrew J Bauer^{2

3}, Yimei Li⁴, Amber Isaza², Tasleema Patel², Lindsay Sisko², Jill P Ginsberg^{3

5}, Ken Kazahaya^{3

6

7}, N Scott Adzick^{3

8}, Sogol Mostoufi-Moab^{2

3

5}

Affiliations

¹ Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, baranj1@chop.edu.
² Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁶ Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁷ Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁸ Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

PMID: 37722360
DOI: 10.1159/000531241

Abstract

Introduction: Childhood cancer survivors (CCS) are at risk for radiotherapy (RT) late effects, including second malignancies. Optimal screening for differentiated thyroid cancer (DTC) in CCS post-RT remains controversial. We assessed the outcome of thyroid ultrasound (US) surveillance in CCS exposed to RT.

Methods: 306 CCS were surveilled with thyroid US between 2002-2021. Surveillance was dependent on age at the time of primary diagnosis, interval from receipt of RT, and individual provider. Thyroid US, clinicopathologic features, and outcomes were described. Cutpoints of CCS RT age associated with varying risk of nodule presentation were explored. The selected cutpoints were used to define age categories, which were then used to compare thyroid nodule-related outcomes. Risk factors for thyroid nodule(s) were evaluated using multivariate logistic regression (odds ratio [OR] [95% confidence interval]).

Results: The most common CCS diagnoses were leukemia (32%), CNS tumor (26%), and neuroblastoma (18%). Patients received TBI (45%) and/or RT to craniospinal (44%), chest (11%), and neck regions (6%). About 49% (n = 150) of patients had thyroid nodule(s). Forty-four patients underwent surgery, and 28 had DTC: 19 with American Thyroid Association (ATA) low-risk classification, 2 with ATA intermediate-risk, and 7 with ATA high-risk disease. Age cutpoint analyses identified cutpoints 3 and 10; hence, ≤3, >3 to ≤10, and >10 years were used. Of the 9 patients with intermediate- or high-risk disease, 8 were ≤10 years and 1 was >10 years at the time of RT. Female sex (OR = 1.62 [1.13-2.12] p = 0.054) and greater interval between RT and first US (OR = 1.10 [1.04-1.16] p = 0.001) were independent risk factors for nodule presentation.

Conclusions: Thyroid US surveillance may be beneficial for CCS exposed to RT at younger ages (≤10 years) for earlier detection of DTC, prior to developing advanced metastatic disease.

Keywords: Childhood cancer survivors; Head and neck radiation; Survivorship; Thyroid; Ultrasound surveillance.