Ultrasound versus physical exam to screen for secondary thyroid cancer among high-risk childhood cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21528-e21528
Author(s):  
Jennifer Hess ◽  
Alexandra Maria Walsh ◽  
Dorothee Newbern ◽  
Kristian Schafernak ◽  
Tamara Vern-Gross ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Thyroid Cancer ◽  
High Risk ◽  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Physical Exam ◽  
Thyroid Malignancy ◽  
Head Neck

e21528 Background: Thyroid cancer is a common secondary malignancy among childhood cancer survivors who have received radiation to the head, neck and/or upper thorax. The optimal strategy for surveillance for thyroid carcinoma in childhood cancer survivors remains controversial. Current Children’s Oncology Group recommendations are limited to physical exam. The objective of this study was to determine the sensitivity and specificity of thyroid ultrasound versus neck exam by a pediatric endocrinologist in the diagnoses of thyroid cancer in a cohort of high-risk childhood cancer survivors. Methods: Medical records of childhood cancer survivors who received radiotherapy to the head, neck and/or upper thorax were reviewed. These patients were seen in a comprehensive childhood cancer survivorship clinic from 01/01/2010 to 12/31/2017. Patient populations included oncology, bone marrow transplant and brain tumor patients. Results: 226 patients received radiation to the head, neck and/or upper thorax. Of those, 129 patients were male (57%). Sixteen (7.1%) of patients developed a secondary thyroid malignancy including 4 patients previously treated for an oncological malignancy, 9 patients treated with bone marrow transplantation, and 3 patients with a CNS malignancy. Median radiation dose was 1800 cGy (range 400-5940 cGy). Time to thyroid carcinoma diagnosis occurred at a median of 12 years (range 4-19 years) from treatment with radiation. Screening ultrasounds were obtained in 146 (65%) patients while 226 (100%) had a physical exam. Two cases were identified by abnormalities on physical exam. The sensitivity of US was 100% (CI 80.6-100) compared to a sensitivity of 12.5% (CI 3.5-36) using physical exam (P < 0.0001). Screening ultrasound had a specificity of 73% (CI 65.1-80.1) while physical exam yielded a specificity of 100% (CI 98.2-100). Conclusions: Regular screening with ultrasounds provide the greatest sensitivity for detection of secondary thyroid carcinomas after head, neck and upper thorax radiation in childhood cancer survivors. If screening ultrasounds were not routinely utilized in our clinic, 14 of the 16 patients (87.5%) would have had a delay in their diagnosis of a secondary thyroid malignancy. Screening ultrasounds may lead to earlier detection of thyroid carcinomas, with the potential to decrease the need for aggressive surgery, radioiodine therapy and, ultimately, to decrease recurrence risk.

scholarly journals Ultrasound Screening for Thyroid Carcinoma in Childhood Cancer Survivors: A Case Series

2008 ◽  
Vol 93 (12) ◽  
pp. 4840-4843 ◽  
Author(s):  
Enrico Brignardello ◽  
Andrea Corrias ◽  
Giuseppe Isolato ◽  
Nicola Palestini ◽  
Luca Cordero di Montezemolo ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Outcome Measure ◽  
Childhood Cancer Survivors ◽  
Ultrasound Screening ◽  
Thyroid Ultrasound ◽  
Main Outcome Measure ◽  
Head Neck

Context: Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies. Objective: This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors. Patients: A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit. Design: Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1–34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm. Main Outcome Measure: The main outcome measure was the finding of not palpable thyroid cancers. Results: Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these. Conclusions: Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile.

scholarly journals Clinical considerations for the treatment of secondary differentiated thyroid carcinoma in childhood cancer survivors

2020 ◽  
Vol 183 (3) ◽  
pp. P1-P10
Author(s):  
Hanneke M van Santen ◽  
Erik K Alexander ◽  
Scott A Rivkees ◽  
Eva Frey ◽  
Sarah C Clement ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Differentiated Thyroid Carcinoma ◽  
Established Risk Factor ◽  
Number Of Patients ◽  
History Of ◽  
Clinical Considerations

The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience-based opinions of the authors.

Deep learning for improved prediction of late-onset cardiomyopathy among childhood cancer survivors: A report from the St. Jude Lifetime Cohort (SJLIFE).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10545-10545
Author(s):  
Fatma Gunturkun ◽  
Robert L Davis ◽  
Gregory T. Armstrong ◽  
John L. Jefferies ◽  
Kirsten K. Ness ◽  
...  
Keyword(s):  
Neural Network ◽  
Deep Learning ◽  
High Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Learning Approaches ◽  
Baseline Evaluation ◽  
Sensitivity Specificity ◽  
Ecg Data

10545 Background: Early identification of survivors at high risk for treatment-induced cardiomyopathy may allow for prevention and/or early intervention. We utilized deep learning methods using COG guideline-recommended baseline electrocardiography (ECG) to improve prediction of future cardiomyopathy. Methods: SJLIFE is a cohort of 5-year clinically assessed childhood cancer survivors including baseline ECG measurements. Development of cardiomyopathy was identified from clinical and echocardiographic measurement using CTCAE criteria (grade 3-4). We applied deep learning approaches to ECG, treatment exposure and demographic data obtained at baseline SJLIFE assessment. We trained a cascaded model combining a 12-layer 1D convolutional neural network to extract features from waveform ECG signals with a 2-layer dense neural network to embed features from other phenotypic data in tabular format to determine if use of deep learning with ECG data could improve prediction of cardiomyopathy. Results: Among 1,218 subjects (median age 31.7 years, range 18.4-66.4) without cardiomyopathy at baseline evaluation, 616 (51%) were male, 1,041 (85%) white, 157 (13%) African American and 792 (65%) were survivors of lymphoma/leukemia. Follow-up averaged 5 (0.5 to 9) years from baseline examination. Mean chest radiation dose was 1350 cGy (range 0 to 6,200 cGy) and mean cumulative anthracycline dose was 191 mg/m2 (range o to 734 mg/m2). A total of 114 (9.4%) survivors developed cardiomyopathy after baseline. A cascaded deep learning model built on a training set (N = 974 participants) classified cardiomyopathy in the test set (N = 244 participants) using both clinical and ECG data with a sensitivity of 70%, specificity of 73%, and AUC of 0.74 (95% CI 0.63-0.85), compared to a model using clinical data alone (sensitivity 61%, specificity 62%, and AUC 0.67, 95% CI 0.56-0.79). In subgroup analyses, models predicting cardiomyopathy within 0-4 years following baseline had a sensitivity, specificity, and AUC of 77%, 78%, and 0.78 (0.65-0.91), respectively. When predicting cardiomyopathy 5-9 years following baseline, model performance dropped to a sensitivity, specificity, and AUC of 70%, 70%, and 0.68 (0.50-0.87), respectively. Conclusions: Deep learning using ECG at baseline evaluation significantly improved prediction of cardiomyopathy in childhood cancer survivors at high risk for cardiomyopathy. Future directions will incorporate deep learning approaches to echocardiography to further improve prediction.

scholarly journals Absolute Risk Prediction of Second Primary Thyroid Cancer Among 5-Year Survivors of Childhood Cancer

2013 ◽  
Vol 31 (1) ◽  
pp. 119-127 ◽  
Author(s):  
Stephanie A. Kovalchik ◽  
Cécile M. Ronckers ◽  
Lene H.S. Veiga ◽  
Alice J. Sigurdson ◽  
Peter D. Inskip ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Thyroid Nodule ◽  
Absolute Risk ◽  
Childhood Cancer Survivors ◽  
Second Primary ◽  
Cancer Type ◽  
Risk Models ◽  
Treatment Information

Purpose We developed three absolute risk models for second primary thyroid cancer to assist with long-term clinical monitoring of childhood cancer survivors. Patients and Methods We used data from the Childhood Cancer Survivor Study (CCSS) and two nested case-control studies (Nordic CCSS; Late Effects Study Group). Model M1 included self-reported risk factors, model M2 added basic radiation and chemotherapy treatment information abstracted from medical records, and model M3 refined M2 by incorporating reconstructed radiation absorbed dose to the thyroid. All models were validated in an independent cohort of French childhood cancer survivors. Results M1 included birth year, initial cancer type, age at diagnosis, sex, and past thyroid nodule diagnosis. M2 added radiation (yes/no), radiation to the neck (yes/no), and alkylating agent (yes/no). Past thyroid nodule was consistently the strongest risk factor (M1 relative risk [RR], 10.8; M2 RR, 6.8; M3 RR, 8.2). In the validation cohort, 20-year absolute risk predictions for second primary thyroid cancer ranged from 0.04% to 7.4% for M2. Expected events agreed well with observed events for each model, indicating good calibration. All models had good discriminatory ability (M1 area under the receiver operating characteristics curve [AUC], 0.71; 95% CI, 0.64 to 0.77; M2 AUC, 0.80; 95% CI, 0.73 to 0.86; M3 AUC, 0.75; 95% CI, 0.69 to 0.82). Conclusion We developed and validated three absolute risk models for second primary thyroid cancer. Model M2, with basic prior treatment information, could be useful for monitoring thyroid cancer risk in childhood cancer survivors.

Cancer screening in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

2009 ◽  
Vol 27 (18_suppl) ◽  
pp. CRA6501-CRA6501 ◽  
Author(s):  
P. C. Nathan ◽  
K. K. Ness ◽  
M. M. Hudson ◽  
M. Mahoney ◽  
J. S. Ford ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Pap Smear ◽  
Malignant Neoplasm ◽  
Childhood Cancer Survivors ◽  
Cancer Center ◽  
Second Malignant Neoplasm ◽  
Increased Risk ◽  
Population Controls

CRA6501 Background: Childhood cancer survivors may develop a second malignant neoplasm (SMN) and require surveillance to detect new cancers. Methods: We surveyed survivors and siblings from the CCSS, a cohort study of patients who have survived ≥5 years after a diagnosis of childhood cancer from 1970–86. We assessed compliance with the American Cancer Society's (ACS) guidelines for surveillance mammography, colonoscopy and PAP smears, and compared them to a matched population comparison group drawn from the 2003 National Health Interview Survey. Further, we examined compliance with the Children's Oncology Group (COG) guidelines for more frequent colonoscopy, mammography and skin exams in survivors at high risk for cancers of the colon (≥30 Gy pelvic, abdominal or spinal radiation), breast (≥ 20 Gy breast radiation in females) or skin (any radiation). Proportions screened were compared between groups with adjusted generalized estimating equations or log-binomial regression models. Results: There were 8318 survivors (50.6% male, mean age at interview 31.2 ± 7.3 years), 2661 siblings and 8318 population controls. 141/829 (17.6%), 592/855 (70.4%) and 3362/3690 (92.6%) eligible survivors reported a colonoscopy, mammogram, or PAP smear per ACS guidelines. Survivors were less likely than siblings (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.18–0.49) and population controls (OR 0.63; CI 0.50–0.80) to have a colonoscopy, and less likely than siblings to have a PAP smear (risk ratio [RR] 0.98; CI 0.97–0.99). However, they were more likely than siblings (RR 1.14; CI 1.03–1.27) and population controls (RR 1.05; CI 1.01–1.10) to have a mammogram. Among survivors at increased risk for a SMN, only 92/809 (11.4%) reported a colonoscopy within the COG recommended 5-year period, 164/537 (30.5%) reported a mammogram within a 1-year period and 1288/4833 (26.7%) reported a skin exam. Care at a cancer center was associated with mammography (RR 1.91; 95% CI 1.02–1.27) and skin exam (RR 1.55; 95% CI 1.22–196) in high-risk patients. Conclusions: Childhood cancer survivors are not screened adequately for SMNs. Surveillance is very poor amongst those at highest risk for colon, breast, or skin cancer. Survivors and their physicians need education about the importance of surveillance. No significant financial relationships to disclose.

Implementation of an integrative wellness program for pediatric cancer survivors at risk for cardiac late-effects.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 168-168 ◽  
Author(s):  
Theresa C DiSipio ◽  
Frances Zappalla ◽  
Joanne Quillen
Keyword(s):  
At Risk ◽  
High Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Pediatric Cancer ◽  
Late Effects ◽  
Childhood Cancer Survivors ◽  
Relaxation Techniques ◽  
Cardiac Events ◽  
Pediatric Cancer Survivors

168 Background: Many adult childhood cancer survivors are at risk of developing adverse health outcomes as a result of their previous diagnosis and treatments. Cardiac events are the most common cause of non-malignant mortality among pediatric cancer survivors; one in eight will develop severe cardiac disease (Lipshultz et al, 2012). The use of integrative therapies in the survivorship setting has the potential to reduce risk of developing late effects and assist with positive coping mechanisms (Kelly, 2009). Early exposure to anti-inflammatory nutrition, yoga and relaxation techniques in combination with thorough cardiac monitoring has the potential to reduce feelings of anxiety and fear of recurrence while catalyzing positive lifestyle modifications and improving overall wellness. Methods: In partnership with the Department of Cardiology at AIDHC, childhood cancer survivors at moderate-to-high risk were identified and referred for integrative cardiology consults (ICC) with a goal of providing an introduction to integrative medicine approaches, and a long-term emphasis on decreasing the incidence of future adverse cardiac events. Patients were approached during their routine post-therapy follow-up appointments. Cardiology consult orders were placed by the oncology provider through the electronic medical record (EPIC) via smart phrasing. Results: A total of 15 patients and families were approached. All 15 complied to ICC in conjunction with their routine ECHO/EKG testing. 47% of the referred patients were exposed to both anthracycline chemotherapy and radiation. 17% presented with significant cardiac related family medical history and 40% had existing comorbidities or lifestyles that may affect future cardiac health. Conclusions: Implementing an ICC standard for childhood cancer survivors at moderate-to-high risk for cardiac late-effects has been successful for AIDHC’s Cancer Survivorship Clinic and shows promise as a preventative intervention. Efficacy will be assessed by measuring patient and family knowledge pre and post ICC in the future.

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