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No Damaging Effect of Chemotherapy in Addition to Radiotherapy on the Thyroid Axis in Young Adult Survivors of Childhood Cancer

Departments of Pediatric Endocrinology, Clinical Epidemiology, and Biostatistics, Late Effects Study Group, Medical Informatics, Medical Oncology, Pediatrics and Pediatric Oncology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands

Address all correspondence and requests for reprints to: H. M. van Santen, M.D., Department of Pediatric Endocrinology, Emma Children’s Hospital, Academic Medical Center, G8-205, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: h.m.vansanten{at}amc.uva.nl.

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.

This work was supported by Emma Children’s Hospital, Academic Medical Center, Stichting Kindergeneeskundig Kankeronderzoek, Pharmacia BV.

Presented in part at the meeting of the European Society for Pediatric Endocrinology 2001 (abstract published in Pediatr Res 49(Suppl):161A, 2001) and at the meeting of the Société Internationale d’Oncologie Pédiatrique 2001 (abstract published in Med Pediatr Oncol 37:303, 2001).

Abbreviations: ALL, Acute lymphoblastic leukemia; HD, Hodgkin’s disease; NHL, non-Hodgkin lymphoma.

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