Authors (including presenting author) :
Samantha Lai Ka Lee, Joanna Yuet Ling Tung
Affiliation :
Endocrine team, Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital
Introduction :
With improving survival of oncological treatment in paediatric population, surveillance of late effects has become more important. In the Hong Kong Children’s Hospital, the service model allows endocrine clinic to be run in parallel with oncology clinic to optimize the endocrine care for cancer survivors. Although survivors who have received radiation involving head, neck and whole body are at risk of thyroid malignancies [1.2], it remains controversial on the optimal strategies for surveillance and lacks a well-defined protocol for ultrasound surveillance for early detection [3].
Objectives :
To achieve early detection of thyroid carcinoma in paediatric oncology survivors who have received irradiation in proximity of the thyroid area. To evaluate the efficacy of a pre-defined protocol for ultrasound surveillance for thyroid carcinoma in this specific population.
Methodology :
A protocol has been devised, in accordance to the risk of thyroid cancer in oncology survivors who have received radiotherapy [4,5], for ongoing surveillance of thyroid carcinoma in this specific population. The protocol has been in place since early June 2019. For paediatric oncology survivors, aged 18 years or less, who has received cranial irradiation, the initial ultrasound of thyroid is scheduled at 5 years from radiotherapy and then every 2-3 yearly. For survivors who had received total body irradiation, the initial ultrasound of thyroid is scheduled at 3 years from radiotherapy and then every 2-3 yearly. A cross-section review has been embarked for all the eligible survivors who attended endocrine clinic between 1/1/2020 to 30/6/2020 and who had ever received the surveillance ultrasound of thyroid in accordance to the pre-defined protocol.
Result & Outcome :
Ten eligible survivors who received cranial irradiation had undergone the surveillance, 5 had thyroid cysts or nodules documented, of whom ultrasound guided fine needle aspiration cytology was performed in 3, and 2 were diagnosed to have thyroid carcinoma in absence of distant metastasis. Four eligible survivors who received total body irradiation had undergone the surveillance and all ultrasound findings were normal. All those who had undergone surveillance were asymptomatic of thyroid disease on clinical examination.
Conclusion:
This pilot study has shown surveillance for thyroid carcinoma is important for early detection in the high risk paediatric oncological survivors who have ever received cranial irradiation. For the impact of total body irradiation, it remains to be determined as the sample size is limited within the pilot study time-frame. Further long-term data is required to assess the cost-effectiveness of the strategies prospectively.
References:
1. Ho WL, Zacharin MR. Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure. Eur J Pediatr. 2016;175(5):677–683.
2. Hameed R, Zacharin MR. Changing face of paediatric and adolescent thyroid cancer. J Paediatr Child Health. 2005;41(11):572–574.
3. Clement SC, Kremer LCM, Verburg FA, Simmons JH, Goldfarb M, Peeters RP et al. Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Cancer Treat Rev. 2018 Feb;63:28-39.
4. Brignardello E, Felicetti F, Castiglione A, Gallo M, Maletta F, Isolato G, Biasin E, Fagioli F, Corrias A, Palestini N. Ultrasound surveillance for radiation-induced thyroid carcinoma in adult survivors of childhood cancer. Eur J Cancer. 2016 Mar;55:74-80.
5. Vivanco M, Dalle JH, Alberti C, Lescoeur B, Yakouben K, Carel JC, Baruchel A, Léger J. Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood. Eur J Endocrinol. 2012 Aug;167(2):225-33.
