Second thyroid neoplasms after prophylactic cranial irradiation for acute lymphoblastic leukemia

• Published in: American journal of hematology Vol. 59; no. 1; pp. 91 - 94
• Main Authors: Perel, Yves, Leverger, Guy, Carrere, Anne, Caudry, Michel, Garabedian, Erea Noel, Ansoborlo, Sophie, Vergnes, Pierre
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01-09-1998; Wiley-Liss
• Subjects: acute lymphoblastic leukemia; Adolescent; Biological and medical sciences; Child, Preschool; Cranial Irradiation - adverse effects; Female; Hemopathies; Humans; Infant; Male; Medical sciences; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy; radiation‐induced; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); second neoplasm; thyroid carcinoma irradiation; Thyroid Neoplasms - etiology; Thyroid Neoplasms - secondary; Endocrinopathy; Human; Carcinoma; Acute; Thyroid diseases; Male; Infant; Malignant hemopathy; Thyroid gland; Malignant tumor; Radiotherapy; Case study; Prevention; Second cancer; Lymphoproliferative syndrome; Complication; Skull; Female; Acute lymphocytic leukemia; Child
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/(SICI)1096-8652(199809)59:1<91::AID-AJH18>3.0.CO;2-4

An understanding of the pathogenesis of second cancers may help in their prevention. We report on two children who were treated for acute lymphoblastic leukemia (ALL), with an exclusively cranial prophylactic irradiation (18 Gy) and who presented with a thyroid carcinoma (TC) 12 and 13 years later. From a thorough review of the literature of TC after ALL and of radiation‐induced TC, a strong case can be made that these tumors are caused by late effects of scattered radiation. The risk is at its highest in small children. After cranial irradiation, patients require clinical monitoring of the thyroid and cervical area for nodules, continued indefinitely. We suggest that, in most cases, an alternative form of neuromeningeal prophylaxis should be offered in small children with ALL. Am. J. Hematol. 59:91–94, 1998. © 1998 Wiley‐Liss, Inc.