Neck radiation, thyroid cancer, and avoiding harm.

Recurrence and Secondary Malignancies
Session Type and Session Title: 
Poster Session A
General Session 3: Surveillance for Recurrence and Second Cancers
Abstract Number: 


Poster Board Number: 
Poster Session A Board #B2
J Clin Oncol 34, 2016 (suppl 3S; abstr 254)
Dana Barnea, Emily S. Tonorezos, Chaya S. Moskowitz, Joanne F. Chou, Elena B. Elkin, Charles A. Sklar, Richard J. Wong, Duan Li, R. Michael Tuttle, Deborah Korenstein, Suzanne L. Wolden, Kevin C. Oeffinger; Memorial Sloan Kettering Cancer Center, New York, NY

Abstract Disclosures


Background: Radiation including the neck area is associated with thyroid cancer, leading some to recommend periodic screening ultrasound. Because thyroid cancer is generally indolent with 5-year cure rates exceeding 98% and thyroid nodules are ubiquitous following therapeutic radiation, the Children’s Oncology Group (COG) recommends an annual palpation of the thyroid. Methods: We conducted a retrospective review of all adult survivors treated for a childhood or young adult cancer with radiation including the neck field who were evaluated in the Adult LTFU Program from November 1, 2005 through January 31, 2015. We excluded individuals who had a previous diagnosis of a thyroid nodule or thyroid cancer prior to their first evaluation. We calculated the negative predictive value of an annual thyroid exam using histologic thyroid cancer within one year of a visit as the reference standard. Results: Among 585 eligible individuals (48.2% females) median age at first evaluation was 30.2 (range, 18.2 to 77.8); 40 survivors (6.8%) had a thyroid nodule palpated on physical examination at a median of 21 years from radiation (range, 4.5 to 44.4). Ultrasonography, performed on 39 survivors, was suspicious in 62% (24/39); FNA performed on these 24 survivors revealed 7 with papillary carcinoma, of which one was locally advanced and none had distant metastases. With a median of 2.2 years of follow-up from diagnosis of thyroid cancer (range, 1 to 7.4 years), 6 patients were doing well and were free of disease. One patient with a regional recurrence was being followed with active surveillance and was doing well. No deaths were attributable to thyroid cancer. The negative predictive value of an annual thyroid exam was 100%. Conclusions: Herein, we describe a standardized step-wise approach for detection of thyroid cancer in a high risk population. No clinically significant thyroid cancer has been missed using thyroid palpation as the initial screening test in our program. These results support the COG guidelines and suggest that annual palpation of the thyroid is an adequate and safe means of screening this high risk population.