TY - JOUR
T1 - Risk of thyroid cancer after therapeutic irradiation in adult patients
T2 - An Age-Based surveillance, epidemiology, and end results analysis
AU - Dalwadi, Shraddha M.
AU - Dorman, Clark
AU - Fisher, Sarah B.
AU - Bonnen, Mark
AU - Grubbs, Elizabeth
AU - Ludwig, Michelle S.
N1 - Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objectives/Hypothesis: One risk of radiation therapy exposure (XRTe) is second primary thyroid cancer (SPTC). Previous reports examined this in children, but no population-based studies have explored XRTe and SPTC across all ages or stratified by histological subtypes. Study Design: Database study. Methods: We report patient characteristics of a Surveillance, Epidemiology, and End Results (SEER) dataset of SPTC (n = 4,669) using χ2 and t tests. Odds ratio (OR) for SPTC was determined based on age, histology, and XRTe compared to expected values in the SEER database. Kaplan-Meier survival and Cox proportional hazard ratios were reported to determine factors influencing latent survival (LS; time from initial diagnosis to SPTC) and overall survival in univariate and multivariate models. Results: Extrathyroid extension and node status based on XRTe were similar (P =.684 and P =.776, respectively). XRTe patients were more likely to have smaller tumors (17.6 vs. 19.3 mm, P =.007). XRTe patients were diagnosed with SPTC at younger ages (59.8 vs. 62.7 years, P <.001) without a difference in LS (7.45 vs. 7.50 years, P =.426). Patients aged 1 to 14 years and 15 to 29 years at diagnosis of first cancer are at higher risk of SPTC after XRTe (OR = 1.89, P =.005 and OR = 2.35, P =.001, respectively), unlike patients age 30 to 44 years and 45+ years (OR = 1.03, P =.823 and OR = 0.97, P =.624, respectively). This difference is not present for follicular and medullary SPTC. Conclusions: Patients aged 30+ years receiving radiation therapy (XRT) do not have an increased risk of SPTC. Deliberation is necessary in recommending, planning, and delivering XRT to minimize risk of subsequent malignancy in younger patients. Level of Evidence: NA Laryngoscope, 130: 2081–2086, 2020.
AB - Objectives/Hypothesis: One risk of radiation therapy exposure (XRTe) is second primary thyroid cancer (SPTC). Previous reports examined this in children, but no population-based studies have explored XRTe and SPTC across all ages or stratified by histological subtypes. Study Design: Database study. Methods: We report patient characteristics of a Surveillance, Epidemiology, and End Results (SEER) dataset of SPTC (n = 4,669) using χ2 and t tests. Odds ratio (OR) for SPTC was determined based on age, histology, and XRTe compared to expected values in the SEER database. Kaplan-Meier survival and Cox proportional hazard ratios were reported to determine factors influencing latent survival (LS; time from initial diagnosis to SPTC) and overall survival in univariate and multivariate models. Results: Extrathyroid extension and node status based on XRTe were similar (P =.684 and P =.776, respectively). XRTe patients were more likely to have smaller tumors (17.6 vs. 19.3 mm, P =.007). XRTe patients were diagnosed with SPTC at younger ages (59.8 vs. 62.7 years, P <.001) without a difference in LS (7.45 vs. 7.50 years, P =.426). Patients aged 1 to 14 years and 15 to 29 years at diagnosis of first cancer are at higher risk of SPTC after XRTe (OR = 1.89, P =.005 and OR = 2.35, P =.001, respectively), unlike patients age 30 to 44 years and 45+ years (OR = 1.03, P =.823 and OR = 0.97, P =.624, respectively). This difference is not present for follicular and medullary SPTC. Conclusions: Patients aged 30+ years receiving radiation therapy (XRT) do not have an increased risk of SPTC. Deliberation is necessary in recommending, planning, and delivering XRT to minimize risk of subsequent malignancy in younger patients. Level of Evidence: NA Laryngoscope, 130: 2081–2086, 2020.
KW - Radiation
KW - epidemiology
KW - thyroid cancer
UR - http://www.scopus.com/inward/record.url?scp=85075335463&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075335463&partnerID=8YFLogxK
U2 - 10.1002/lary.28407
DO - 10.1002/lary.28407
M3 - Article
C2 - 31747075
AN - SCOPUS:85075335463
SN - 0023-852X
VL - 130
SP - 2081
EP - 2086
JO - Laryngoscope
JF - Laryngoscope
IS - 8
ER -