Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?
Background: Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains c...
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| Veröffentlicht in: | Thyroid (New York, N.Y.) N.Y.), 2017-08, Vol.27 (8), p.168-1076 |
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| creator | Silva-Vieira, Margarida Carrilho Vaz, Sofia Esteves, Susana Ferreira, Teresa C. Limbert, Edward Salgado, Lucília Leite, Valeriano |
| description | Background:
Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients.
Methods:
This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included.
Results:
The median age of patients was 48 years (range 5–90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0–17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT–). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT–. The absolute risk increase in the RAIT+ group versus the RAIT– group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011–0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0–87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT– group (
p
= 0.026; relative risk = 1.84 [CI 1.02–3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively).
Conclusion:
These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer. |
| doi_str_mv | 10.1089/thy.2016.0655 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1910337199</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1910337199</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-eaf59c2f18a32d088823adc82406ecef7022a8d0dd5a0299c8f37f5fc90c06823</originalsourceid><addsrcrecordid>eNqF0E1LAzEQgOEgitXq0avk6GXrJGt2Ey8irV9QsPhxXmIyoZHtpiZbpP_elFavnpIMDxN4CTljMGIg1WU_X484sGoElRB75IgJURcK6no_30FAUXNRDchxSp-QmazLQzLgsmJXSpZHxLyiCZ2ls-gXOq7pWHcGI_UdneneY9cn-u37OZ145zDmt9c9Wvo2X8fg7Y5f00nARF-09cEH6zuks1avqaYvocWbE3LgdJvwdHcOyfv93dv4sZg-PzyNb6eFKcu6L1A7oQx3TOqSW5BS8lJbI_kVVGjQ1cC5lhasFRq4Uka6snbCGQUGqoyH5GK7dxnD1wpT3yx8Mti2usOwSg1TDPJPTKlMiy01MaQU0TXLbYCGQbPp2uSuzaZrs-ma_flu9epjgfZP_4bMoNyCzVh3XevxA2P_z9ofTtiE5Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1910337199</pqid></control><display><type>article</type><title>Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Silva-Vieira, Margarida ; Carrilho Vaz, Sofia ; Esteves, Susana ; Ferreira, Teresa C. ; Limbert, Edward ; Salgado, Lucília ; Leite, Valeriano</creator><creatorcontrib>Silva-Vieira, Margarida ; Carrilho Vaz, Sofia ; Esteves, Susana ; Ferreira, Teresa C. ; Limbert, Edward ; Salgado, Lucília ; Leite, Valeriano</creatorcontrib><description>Background:
Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients.
Methods:
This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included.
Results:
The median age of patients was 48 years (range 5–90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0–17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT–). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT–. The absolute risk increase in the RAIT+ group versus the RAIT– group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011–0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0–87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT– group (
p
= 0.026; relative risk = 1.84 [CI 1.02–3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively).
Conclusion:
These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer.</description><identifier>ISSN: 1050-7256</identifier><identifier>EISSN: 1557-9077</identifier><identifier>DOI: 10.1089/thy.2016.0655</identifier><identifier>PMID: 28614983</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cancer Care Facilities ; Cell Differentiation ; Child ; Child, Preschool ; Cohort Studies ; Dose-Response Relationship, Radiation ; Female ; Follow-Up Studies ; Health Transition ; Humans ; Incidence ; Iodine Radioisotopes - administration & dosage ; Iodine Radioisotopes - adverse effects ; Iodine Radioisotopes - therapeutic use ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Radiation-Induced - epidemiology ; Neoplasms, Radiation-Induced - etiology ; Neoplasms, Second Primary - epidemiology ; Neoplasms, Second Primary - etiology ; Portugal - epidemiology ; Radiopharmaceuticals - adverse effects ; Radiopharmaceuticals - therapeutic use ; Registries ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - radiotherapy ; Thyroid Radiology and Nuclear Medicine ; Young Adult</subject><ispartof>Thyroid (New York, N.Y.), 2017-08, Vol.27 (8), p.168-1076</ispartof><rights>2017, Mary Ann Liebert, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-eaf59c2f18a32d088823adc82406ecef7022a8d0dd5a0299c8f37f5fc90c06823</citedby><cites>FETCH-LOGICAL-c337t-eaf59c2f18a32d088823adc82406ecef7022a8d0dd5a0299c8f37f5fc90c06823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28614983$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silva-Vieira, Margarida</creatorcontrib><creatorcontrib>Carrilho Vaz, Sofia</creatorcontrib><creatorcontrib>Esteves, Susana</creatorcontrib><creatorcontrib>Ferreira, Teresa C.</creatorcontrib><creatorcontrib>Limbert, Edward</creatorcontrib><creatorcontrib>Salgado, Lucília</creatorcontrib><creatorcontrib>Leite, Valeriano</creatorcontrib><title>Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?</title><title>Thyroid (New York, N.Y.)</title><addtitle>Thyroid</addtitle><description>Background:
Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients.
Methods:
This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included.
Results:
The median age of patients was 48 years (range 5–90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0–17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT–). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT–. The absolute risk increase in the RAIT+ group versus the RAIT– group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011–0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0–87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT– group (
p
= 0.026; relative risk = 1.84 [CI 1.02–3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively).
Conclusion:
These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer Care Facilities</subject><subject>Cell Differentiation</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health Transition</subject><subject>Humans</subject><subject>Incidence</subject><subject>Iodine Radioisotopes - administration & dosage</subject><subject>Iodine Radioisotopes - adverse effects</subject><subject>Iodine Radioisotopes - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Neoplasms, Radiation-Induced - epidemiology</subject><subject>Neoplasms, Radiation-Induced - etiology</subject><subject>Neoplasms, Second Primary - epidemiology</subject><subject>Neoplasms, Second Primary - etiology</subject><subject>Portugal - epidemiology</subject><subject>Radiopharmaceuticals - adverse effects</subject><subject>Radiopharmaceuticals - therapeutic use</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - radiotherapy</subject><subject>Thyroid Radiology and Nuclear Medicine</subject><subject>Young Adult</subject><issn>1050-7256</issn><issn>1557-9077</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0E1LAzEQgOEgitXq0avk6GXrJGt2Ey8irV9QsPhxXmIyoZHtpiZbpP_elFavnpIMDxN4CTljMGIg1WU_X484sGoElRB75IgJURcK6no_30FAUXNRDchxSp-QmazLQzLgsmJXSpZHxLyiCZ2ls-gXOq7pWHcGI_UdneneY9cn-u37OZ145zDmt9c9Wvo2X8fg7Y5f00nARF-09cEH6zuks1avqaYvocWbE3LgdJvwdHcOyfv93dv4sZg-PzyNb6eFKcu6L1A7oQx3TOqSW5BS8lJbI_kVVGjQ1cC5lhasFRq4Uka6snbCGQUGqoyH5GK7dxnD1wpT3yx8Mti2usOwSg1TDPJPTKlMiy01MaQU0TXLbYCGQbPp2uSuzaZrs-ma_flu9epjgfZP_4bMoNyCzVh3XevxA2P_z9ofTtiE5Q</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Silva-Vieira, Margarida</creator><creator>Carrilho Vaz, Sofia</creator><creator>Esteves, Susana</creator><creator>Ferreira, Teresa C.</creator><creator>Limbert, Edward</creator><creator>Salgado, Lucília</creator><creator>Leite, Valeriano</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?</title><author>Silva-Vieira, Margarida ; Carrilho Vaz, Sofia ; Esteves, Susana ; Ferreira, Teresa C. ; Limbert, Edward ; Salgado, Lucília ; Leite, Valeriano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-eaf59c2f18a32d088823adc82406ecef7022a8d0dd5a0299c8f37f5fc90c06823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer Care Facilities</topic><topic>Cell Differentiation</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Dose-Response Relationship, Radiation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health Transition</topic><topic>Humans</topic><topic>Incidence</topic><topic>Iodine Radioisotopes - administration & dosage</topic><topic>Iodine Radioisotopes - adverse effects</topic><topic>Iodine Radioisotopes - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Neoplasms, Radiation-Induced - epidemiology</topic><topic>Neoplasms, Radiation-Induced - etiology</topic><topic>Neoplasms, Second Primary - epidemiology</topic><topic>Neoplasms, Second Primary - etiology</topic><topic>Portugal - epidemiology</topic><topic>Radiopharmaceuticals - adverse effects</topic><topic>Radiopharmaceuticals - therapeutic use</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - radiotherapy</topic><topic>Thyroid Radiology and Nuclear Medicine</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silva-Vieira, Margarida</creatorcontrib><creatorcontrib>Carrilho Vaz, Sofia</creatorcontrib><creatorcontrib>Esteves, Susana</creatorcontrib><creatorcontrib>Ferreira, Teresa C.</creatorcontrib><creatorcontrib>Limbert, Edward</creatorcontrib><creatorcontrib>Salgado, Lucília</creatorcontrib><creatorcontrib>Leite, Valeriano</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thyroid (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silva-Vieira, Margarida</au><au>Carrilho Vaz, Sofia</au><au>Esteves, Susana</au><au>Ferreira, Teresa C.</au><au>Limbert, Edward</au><au>Salgado, Lucília</au><au>Leite, Valeriano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?</atitle><jtitle>Thyroid (New York, N.Y.)</jtitle><addtitle>Thyroid</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>27</volume><issue>8</issue><spage>168</spage><epage>1076</epage><pages>168-1076</pages><issn>1050-7256</issn><eissn>1557-9077</eissn><abstract>Background:
Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients.
Methods:
This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included.
Results:
The median age of patients was 48 years (range 5–90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0–17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT–). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT–. The absolute risk increase in the RAIT+ group versus the RAIT– group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011–0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0–87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT– group (
p
= 0.026; relative risk = 1.84 [CI 1.02–3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively).
Conclusion:
These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>28614983</pmid><doi>10.1089/thy.2016.0655</doi><tpages>909</tpages></addata></record> |
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| ispartof | Thyroid (New York, N.Y.), 2017-08, Vol.27 (8), p.168-1076 |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over Cancer Care Facilities Cell Differentiation Child Child, Preschool Cohort Studies Dose-Response Relationship, Radiation Female Follow-Up Studies Health Transition Humans Incidence Iodine Radioisotopes - administration & dosage Iodine Radioisotopes - adverse effects Iodine Radioisotopes - therapeutic use Male Middle Aged Neoplasm Staging Neoplasms, Radiation-Induced - epidemiology Neoplasms, Radiation-Induced - etiology Neoplasms, Second Primary - epidemiology Neoplasms, Second Primary - etiology Portugal - epidemiology Radiopharmaceuticals - adverse effects Radiopharmaceuticals - therapeutic use Registries Retrospective Studies Risk Factors Survival Analysis Thyroid Neoplasms - pathology Thyroid Neoplasms - radiotherapy Thyroid Radiology and Nuclear Medicine Young Adult |
| title | Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role? |
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