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 thyroi...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2003-08, Vol.88 (8), p.3657-3663
Main Authors: van Santen, Hanneke M., Vulsma, Thomas, Dijkgraaf, Marcel G., Blumer, Regje M. E., Heinen, Richard, Jaspers, Monique W. M., Geenen, Maud M., Offringa, Martin O., De Vijlder, Jan J. M., van den Bos, Cor
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antineoplastic Agents - adverse effects
Child
Child, Preschool
Dose-Response Relationship, Drug
Dose-Response Relationship, Radiation
Female
Humans
Hypothyroidism - epidemiology
Hypothyroidism - etiology
Infant
Male
Multivariate Analysis
Neoplasms - drug therapy
Neoplasms - radiotherapy
Neoplasms - therapy
Radiotherapy - adverse effects
Risk Factors
Survivors
Thyroid Diseases - epidemiology
Thyroid Diseases - etiology
Thyroid Function Tests
Thyroid Gland - drug effects
Thyroid Gland - physiology
Thyroid Gland - radiation effects
Thyroid Hormones - blood
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Summary: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.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2003-030209