Management of Secondary Differentiated Thyroid Carcinoma in Childhood Cancer Survivors
Posted: Monday, July 27, 2020
The number of patients who will develop secondary differentiated thyroid cancer is expected to rise as the number of childhood cancer survivors also increases. This is likely the result of exposure to external radiation during cancer treatment during childhood, as well as the additive association of the use of chemotherapy. In the European Journal of Endocrinology, Frederik Verburg, MD, PhD, of the University Hospital Marburg, Marburg, Germany, and colleagues explored considerations for the management of thyroid cancer—specifically for this patient population.
The authors recommend the decision to undergo periodic surveillance be made by the physician in consultation with the patient after careful consideration of the advantages and disadvantages of screening. If a suspicious thyroid nodule is detected, fine-needle aspiration cytology of the lesion is recommended; in the case of an unclear biopsy results, diagnostic (hemi)thyroidectomy should be strongly considered. If medical imaging should be necessary, MRI is preferred.
According to Dr. Verburg and colleagues, there is insufficient genetic or clinical evidence to support a more aggressive treatment strategy for secondary differentiated thyroid cancer in childhood cancer survivors. Medical history should be considered carefully in choosing treatment because late effects from prior treatment, such as cardiac and pulmonary effects, may elevate the risk for toxicity. Restricted use of I-131 therapy is advocated due to an increased risk for developing tertiary cancers, and the possibility of complications with anesthesia in childhood cancer survivors should be assessed.
Finally, treatment should be provided in an experienced thyroid center, and the multidisciplinary team should include a pediatric oncologist to address these special considerations. The authors also highlighted the importance of providing psychological support for these patients.
Disclosure: The authors reported no conflicts of interest.