Journal of Child

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DOI :10.5222/j.child.2019.45822   IUP :10.5222/j.child.2019.45822    Full Text (PDF)

Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma

Mehmet Eltan, Ferhan Akıcı, Gönül Aydoğan, Zafer Şalcıoğlu, Ali Er, Hasan Önal, Ayça İribaş, Mehmet Emin Darendeliler, Deniz Tuğcu

Objective: As the survival rate and duration increases in the treatment of childhood Hodgkin’s Lymphoma, the incidence of side effects resulting from the treatment increases and the late effects of the treatment become increasingly important. The aim of this study was to evaluate the late side effects of chemotherapy and radiotherapy on thyroid functions in patients treated for Hodgkin’s Lymphoma in childhood. Method: Thyroid functions of 40 patients who were treated with diagnosis of Hodgkin’s Lymphoma, between 1994 and 2013, followed up in remission in Istanbul Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Department of Pediatric Hematology and Oncology, were evaluated retrospectively. Results: The mean age of the patients was 14.13±6.081 (range: 4-31) years, and the male / female ratio was 34/6 (85%/15%). The mean follow-up period was 5.54±3.68 years (0.92-13.92). All patients received chemotherapy. Thirty seven patients (92.5%) received radiotherapy to the neck region. The mean radiotherapy dose was 21.4875±4.48726 Gy. Primary disease was localized to head and neck region in 72.5% of our patients. B symptoms were present in 7 patients (17.5%). Hypothyroidism was detected in 12 of 40 patients (30%) and replacement therapy was started in 5 patients (41%) with the diagnosis of clinical hypothyroidism. Eleven (91%) of these patients were male and 1 (9%) was female. Thyroid gland nodules were detected in 5 (12.5%) of our patients. Of 5 patients with thyroid nodules, 3 were male (60%) and 2 were female (40%). Hypothyroidism was 3.10±2.02 years and thyroid nodule was 8.90±7.10 years. Three patients who were selected according to thyroid scintigraphy and thyroid ultrasonography results were referred to thyroid biopsy and no malignancy was detected. Conclusion: Radiation-induced thyroid diseases in pediatric Hodgkin’s Lymphoma patients may develop during the years following treatment, when the disease is in remission. In particular, patients exposed to neck radiotherapy should be closely monitored for the occurrence of thyroid dysfunction.

Keywords: Hodgkin’s Lymphoma, childhood, chemotherapy, thyroid, late side effect
DOI :10.5222/j.child.2019.45822   IUP :10.5222/j.child.2019.45822    Full Text (PDF)

Çocukluk Çağı Hodgkin Lenfoma Nedeniyle Tedavi Gören Hastalarda Tiroid Fonksiyonlarının Değerlendirilmesi

Mehmet Eltan, Ferhan Akıcı, Gönül Aydoğan, Zafer Şalcıoğlu, Ali Er, Hasan Önal, Ayça İribaş, Mehmet Emin Darendeliler, Deniz Tuğcu

Amaç: Çocukluk çağı Hodgkin Lenfoma tedavisinde sağkalım oran ve süresi uzadıkça, tedavi sonucu gelişen yan etkilerin görülme sıklığı artmakta ve tedavinin geç etkileri giderek önem kazanmaktadır. Bu çalışmada çocukluk çağında Hodgkin Lenfoma nedeniyle tedavi gören hastalarda, kemoterapi ve radyoterapinin tiroid fonksiyonları üzerine geç yan etkilerinin değerlendirilmesi amaçlandı. Yöntem: İstanbul Sağlık Bilimleri Üniversitesi, Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, Çocuk Hematoloji ve Onkoloji Kliniği’nde, 1994-2013 yılları arasında Hodgkin Lenfoma tanısı ile tedavi görüp, remisyonda olarak izlenen, en az 6 aydır tedavi almayan, 34’ü erkek, 6’sı kız olmak üzere toplam 40 hastanın tiroid fonksiyonları retrospektif olarak incelendi. Bulgular: Tanı alan hastaların yaş ortalaması 14.13±6.081 (dağılım: 4-31), erkek/kız oranı 34/6 (%85/%15) idi. Ortalama takip süresi 5.54±3.68 yıl (0,92-13,92) idi. Tüm hastalara kemoterapi verildi. Boyun bölgesine radyoterapi 37 hasta (%92,5) almıştı. Ortalama radyoterapi dozu 21.4875±4.48726 Gy idi. Hastalarımızda %72.5 oranında primer hastalık baş-boyun bölgesine lokalize idi. B semptomu 7 hastada (%17,5) vardı. Kırk hastanın 12’inde (%30 hasta) hipotiroidi saptandı, 5 hastaya (%41) klinik hipotiroidi tanısıyla replasman tedavisine başlandı. Bu hastaların 11’i erkek (%91), 1’i kızdı (%9). Hastalarımızın 5’inde (%12.5) yapılan tiroid USG’sinde tiroid bezi nodülü saptandı. Tiroid nodülü saptanan toplam 5 hastanın 3’ü erkek (%60), 2’si kızdı (%40). Hipotiroidi gelişme zamanı 3.10±2.02 yıl, tiroid nodülü oluşma zamanı 8.90±7.10 yıl olarak saptandı. Tiroid sintigrafisi ve tiroid ultrasonografi sonuçlarına göre seçilen üç hasta tiroid biyopsisine yönlendirildi, malinite saptanmadı. Sonuç: Pediatrik Hodgkin Lenfoma hastalarında radyasyona bağlı tiroid hastalıkları, tedaviden sonraki yıllarda, hastalık remisyonda iken gelişebilir. Özellikle boyun radyoterapisine maruz kalmış hastalar, tiroid fonksiyon bozukluklarının ortaya çıkması açısından yakından takip edilmelidir.

Keywords: Hodgkin Lenfoma, çocukluk çağı, kemoterapi, tiroid, geç yan etki

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References

  • 1. Hudson MM, Onciv M, Donaldson SS. Hodgkin lymphoma. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. Philadelphia: Lippincott Williams and Wilkins; 2006. pp. 695-721. google scholar
  • 2. Hodgkin Lymphoma. In: Lanzkowsky P. Manuel of pediatric hematology and oncology. Burlington: Elsevier Academic Press; 2005. pp. 453-490. google scholar
  • 3. Bhatia S, Blatt J, Meadows AT. Late effects of childhood cancer and its treatment. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. Philadelphia: Lippincott Williams and Wilkins; 2006. pp. 1490-1514. google scholar
  • 4. Kutluk T. First Pediatric Cancer Registry in Turkey. A Turkish Pediatric Oncology Group (TPOG) Study Med. And Ped. Oncol. 2004;43:452. google scholar
  • 5. Poyrazoğlu Ş, Baş F, Darendeliler E, Darendeliler F. Çocukluk çağı kanser tedavisinin endokrin geç yan etkileri. Türk Onkoloji Dergisi 2010;25(1):37-46. google scholar
  • 6. Sklar C, Whitton J, Mertens A, Stovall M, Green D, Marina N, Greffe B, et al. Abnormalities of the thyroid in survivors of Hodgkin’s disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab. 2000;85:3227-32. https://doi.org/10.1210/jc.85.9.3227 google scholar
  • 7. Brusamolino E, Lunghi F, Orlandi E, Astori C, Passamonti F, BaratO˜ C, Pagnucco G, Baio A, Franchini P, Lazzaroni M et al. Treatment of early-stage Hodgkin’s disease with four cycles of ABVD followed by adjuvant radiotherapy: analysis of efficacy and long-term toxicity. Haematologica 2000;85:1032-1039. google scholar
  • 8. Solt I, Gaitini D, Pery M, Hochberg Z, Stein M, Arush MW. Comparing thyroid ultrasonography to thyroid function in long-term survivors of childhood lymphoma. Med Pediatr Oncol. 2000;35:35-40. https://doi.org/10.1002/1096-911X(200007)35:1 3.0.CO;2-# google scholar
  • 9. Demirkaya M, Sevinir B, Sağlam H, et al. Thyroid functions in long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy and radiotherapy. J Clin Res Pediatr Endocrinol. 2011;3(2):89-94. https://doi.org/10.4274/jcrpe.v3i2.18 google scholar
  • 10. Inskip PD, Veiga LHS, Brenner AV, Sigurdson AJ, Ostroumova E, Chow EJ, Stovall M, Smith SA, Weathers RE, Leisenring W, Robison LL, Armstrong GT, Sklar CA, Lubin JH. Hypothyroidism after Radiation Therapy for Childhood Cancer: A Report from the Childhood Cancer Survivor Study. Radiat Res. 2018 Aug;190(2):117-32. Epub 2018 May https://doi.org/10.1667/RR14888.1 google scholar
  • 11. Rodriquez DC, Guidoni E, D’ambrosio A, Pochiero F, Caini M, Guglielmucci D, Lucherini M, Carra F, Municchi G. Abnormalities of the thyroid in survivors of childhood Hodgkin’s disease. Minerva Pediatr. 2014 Aug; 66(4):249-56. google scholar
  • 12. Hakvoort-Cammel FG, Buitendijk S, van den HeuvelEibrink MM, Hahlen K. Treatment of pediatric Hodgkin disease avoiding radiotherapy: excellent outcome with the Rotterdam-HD-84-protocol. Pediatr Blood Cancer 2004;43:8-16. https://doi.org/10.1002/pbc.20031 google scholar
  • 13. Metzger ML, Hudson MM, Somes GW, Shorr RI, Li CS, Krasin MJ. White race as a risk factor for hypothyroidism after treatment for pediatric Hodgkin’s lymphoma. J Clin Oncol. 2006;24(10):1516-21. https://doi.org/10.1200/JCO.2005.05.0195 google scholar
  • 14. Constine LS, Donaldson SS, McDougall IR, et al. Thyroid dysfunction after radiotherapy in children with Hodgkin disease. Cancer 1984;53:878-83. https://doi.org/10.1002/1097-0142(19840215)53: 43.0.CO;2-J google scholar
  • 15. Kilickap S, Barista I, Ulger S, Celik I, Selek U, Güllü I, Yildiz F, Kars A, Ozisik Y, Tekuzman G. Long-term complications in Hodgkin’s lymphoma survivors. Tumori. 2012 Sep-Oct;98(5):601-6. https://doi.org/10.1177/030089161209800510 google scholar
  • 16. Meadows AT, Friedman DL, Neglia JP, Mertens AC, Donaldson SS, Stovall M, Hammond S, Yasui Y, Inskip PD. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:2356-62. https://doi.org/10.1200/JCO.2008.21.1920 google scholar
  • 17. Bhatia S, Blatt J, Meadows AT. Late effects of childhood cancer and its treatment. In: Pizzo PA, Poplack DG (eds). Principles and practice of pediatric oncology. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p.1490-514. google scholar
  • 18. Gleeson HK, Shalet SM. Endocrine complications of neoplastic diseases in children and adolescents. Curr Opin Pediatr. 2001;13(4):346-51. https://doi.org/10.1097/00008480-200108000-00011 google scholar
  • 19. Metzger ML, Howard SC, Hudson MM, Gow KW, Li CS, Krasin MJ, et al. Natural history of thyroid nodules in survivors of pediatric Hodgkin lymphoma. Pediatr Blood Cancer 2006;46(3):314-9.s https://doi.org/10.1002/pbc.20541 google scholar
  • 20. Crom DB, Kaste SC, Tuburgen DG, et al. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. Medical Pediatric Oncology 1997;28:15-21. 131 M. Eltan ve ark., Çocukluk Çağı Hodgkin Lenfoma Nedeniyle Tedavi Gören Hastalarda Tiroid Fonksiyonlarının Değerlendirilmesi https://doi.org/10.1002/(SICI)1096-911X(199701) 28:13.0.CO;2-W google scholar
  • 21. Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med. 1991;325:599-605. https://doi.org/10.1056/NEJM199108293250902 google scholar
  • 22. Solt I, Gaitini D, Pery M, Hochberg Z, Stein M, Arush MW. Comparing thyroid ultrasonography to thyroid function in long-term survivors of childhood lymphoma. Med Pediatr Oncol. 2000;35:35-40. https://doi.org/10.1002/1096-911X(200007)35:1 3.0.CO;2-# google scholar
  • 23. Hudson MM, Greenwald C, Thompson E, Wilimas J, Marina N, Fairclough D, Kauffman W, Bozeman P, Mackert PW, Abromowitch M et al. Efficacy and toxicity of multiagent chemotherapy and low-dose involved-field radiotherapy in children and adolescents with Hodgkin’s disease. J Clin Oncol. 1993; 11:100-8. https://doi.org/10.1200/JCO.1993.11.1.100 google scholar
  • 24. van Beek RD, van den Heuvel-Eibrink MM, HakvoortCammel FG, van den Bos C, van der Pal HJ, Krenning EP, de Rijke YB, Pieters R, de Muinck Keizer-Schrama SM. Bone mineral density, growth and thyroid function in long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy only. J Clin Endocrinol Metab. 2009;94:1904-9. https://doi.org/10.1210/jc.2008-0622 google scholar
  • 25. Bhatia S, Yasui Y, Robison LL, et al. High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin’s disease: report from the Late Effects Study Group. J Clin Oncol. 2003;21:4386-94. https://doi.org/10.1200/JCO.2003.11.059 google scholar
  • 26. Chowdhry AK, Fung C, Chowdhry VK, Bergsma D, Dhakal S, Constine LS, Milano MT. A population-based study of prognosis and survival in patients with second primary thyroid cancer after Hodgkin lymphoma. Leuk Lymphoma. 2018 May;59(5):1180-7. Epub 2017 Sep 1. https://doi.org/10.1080/10428194.2017.1369063 google scholar
  • 27. Sigurdson AJ, Ronckers CM, Mertens AC, Stovall M, Smith SA, Liu Y, et al. Primary thyroid cancer after a first tumour in childhood (the Childhood Cancer Survivor Study): a nested case-control study. Lancet. 2005;365:2014-23. https://doi.org/10.1016/S0140-6736(05)66695-0 google scholar
  • 28. Dörffel W, Riepenhausenl M, Lüders H, Brämswig J, Schellong G. Secondary Malignancies Following Treatment for Hodgkin’s Lymphoma in Childhood and Adolescence. Dtsch Arztebl Int. 2015 May 1; 112(18):320-7. https://doi.org/10.3238/arztebl.2015.0320 google scholar
  • 29. Sigurdson AJ, Ronckers CM, Mertens AC, Stovall M, Smith SA, Liu Y, et al. Primary thyroid cancer after a first tumour in childhood (the Childhood Cancer Survivor Study): a nested case-control study. Lancet. 2005;365:2014-23. https://doi.org/10.1016/S0140-6736(05)66695-0 google scholar
  • 30. O’Brien MM, Donaldson SS, Balise RR, Whittemore AS, Link MP. Second malignant neopplasms in survivors of pediatric Hodgkin’s lymphoma treated with low-dose radiation and chemotherapy. J Clin Oncol. 2010; 28:1232-9. https://doi.org/10.1200/JCO.2009.24.8062 google scholar
  • 31. Ron E, Modan B, Preston D, Alfandary E, Stovall M, Boice JD Jr. Thyroid neoplasia following low-dose radiation in childhood. Radiat Res. 1989;120(3):516-31. https://doi.org/10.2307/3577801 google scholar
  • 32. Tonorezos ES, Barnea D, Moskowitz CS, Chou JF, Sklar CA, Elkin EB, Wong RJ, et al. Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation. J Cancer Surviv. 2017 Jun;11(3):302-8. https://doi.org/10.1007/s11764-016-0588-6 google scholar

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APA

Eltan, M., Akıcı, F., Aydoğan, G., Şalcıoğlu, Z., Er, A., Önal, H., İribaş, A., Darendeliler, M.E., & Tuğcu, D. (2019). Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child, 19(3), 124-131. https://doi.org/10.5222/j.child.2019.45822


AMA

Eltan M, Akıcı F, Aydoğan G, Şalcıoğlu Z, Er A, Önal H, İribaş A, Darendeliler M E, Tuğcu D. Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child. 2019;19(3):124-131. https://doi.org/10.5222/j.child.2019.45822


ABNT

Eltan, M.; Akıcı, F.; Aydoğan, G.; Şalcıoğlu, Z.; Er, A.; Önal, H.; İribaş, A.; Darendeliler, M.E.; Tuğcu, D. Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child, [Publisher Location], v. 19, n. 3, p. 124-131, 2019.


Chicago: Author-Date Style

Eltan, Mehmet, and Ferhan Akıcı and Gönül Aydoğan and Zafer Şalcıoğlu and Ali Er and Hasan Önal and Ayça İribaş and Mehmet Emin Darendeliler and Deniz Tuğcu. 2019. “Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma.” Journal of Child 19, no. 3: 124-131. https://doi.org/10.5222/j.child.2019.45822


Chicago: Humanities Style

Eltan, Mehmet, and Ferhan Akıcı and Gönül Aydoğan and Zafer Şalcıoğlu and Ali Er and Hasan Önal and Ayça İribaş and Mehmet Emin Darendeliler and Deniz Tuğcu. “Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma.” Journal of Child 19, no. 3 (Dec. 2024): 124-131. https://doi.org/10.5222/j.child.2019.45822


Harvard: Australian Style

Eltan, M & Akıcı, F & Aydoğan, G & Şalcıoğlu, Z & Er, A & Önal, H & İribaş, A & Darendeliler, ME & Tuğcu, D 2019, 'Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma', Journal of Child, vol. 19, no. 3, pp. 124-131, viewed 23 Dec. 2024, https://doi.org/10.5222/j.child.2019.45822


Harvard: Author-Date Style

Eltan, M. and Akıcı, F. and Aydoğan, G. and Şalcıoğlu, Z. and Er, A. and Önal, H. and İribaş, A. and Darendeliler, M.E. and Tuğcu, D. (2019) ‘Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma’, Journal of Child, 19(3), pp. 124-131. https://doi.org/10.5222/j.child.2019.45822 (23 Dec. 2024).


MLA

Eltan, Mehmet, and Ferhan Akıcı and Gönül Aydoğan and Zafer Şalcıoğlu and Ali Er and Hasan Önal and Ayça İribaş and Mehmet Emin Darendeliler and Deniz Tuğcu. “Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma.” Journal of Child, vol. 19, no. 3, 2019, pp. 124-131. [Database Container], https://doi.org/10.5222/j.child.2019.45822


Vancouver

Eltan M, Akıcı F, Aydoğan G, Şalcıoğlu Z, Er A, Önal H, İribaş A, Darendeliler ME, Tuğcu D. Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child [Internet]. 23 Dec. 2024 [cited 23 Dec. 2024];19(3):124-131. Available from: https://doi.org/10.5222/j.child.2019.45822 doi: 10.5222/j.child.2019.45822


ISNAD

Eltan, Mehmet - Akıcı, Ferhan - Aydoğan, Gönül - Şalcıoğlu, Zafer - Er, Ali - Önal, Hasan - İribaş, Ayça - Darendeliler, MehmetEmin - Tuğcu, Deniz. “Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma”. Journal of Child 19/3 (Dec. 2024): 124-131. https://doi.org/10.5222/j.child.2019.45822



TIMELINE


Submitted07.11.2019
Accepted22.11.2019
Published Online05.12.2019

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