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Cáncer de tiroides primario después de un primer tumor en la infancia (el Estudio de Sobrevivientes de Cáncer
Alice J Sigurdson1, Cécile M Ronckers, Ann C Mertens
1Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7238, USA. sigurdsa@mail.nih.gov
Lancet (London, England)
|June 14, 2005
Resumen
Los sobrevivientes de cáncer infantil tratados con radioterapia en la cabeza, el cuello o el tórax se enfrentan a un mayor riesgo de cáncer de tiroides. Este riesgo aumenta con la dosis de radiación hasta 30 Gy, luego disminuye, posiblemente debido a los efectos de muerte celular.
Área de la Ciencia:
- Oncología Oncología.
- Radioncología Oncología de la radiación.
- Epidemiología La epidemiología.
Sus antecedentes:
- Los sobrevivientes de cáncer infantil tratados con radioterapia en la cabeza, el cuello o la parte superior del tórax tienen un riesgo elevado de desarrollar posteriormente cáncer de tiroides primario.
- La magnitud exacta de este riesgo a través de los rangos de dosis de radiación terapéutica sigue siendo incompletamente entendida.
Objetivo del estudio:
- Cuantificar el riesgo a largo plazo de cáncer de tiroides después de la radioterapia y la quimioterapia en sobrevivientes de cáncer infantil.
- Para investigar la relación dosis-respuesta entre la exposición a la radiación y el desarrollo de cáncer de tiroides.
Principales métodos:
- Se realizó un estudio de casos y controles anidados utilizando datos de la cohorte del Estudio de Sobrevivientes de Cáncer Infantil.
- Se identificaron 69 casos de cáncer de tiroides y 265 controles emparejados de 14.054 sobrevivientes de cinco años diagnosticados con cáncer infantil entre 1970 y 1986, con seguimiento hasta el año 2000.
Principales resultados:
- El riesgo de cáncer de tiroides aumentó significativamente con dosis de radiación de hasta 20-29 Gy (OR 9.8).
- Se observó una disminución en la relación dosis-respuesta a dosis superiores a 30 Gy, lo que potencialmente indica un efecto de muerte celular.
- Tanto el aumento como la disminución de los riesgos fueron más pronunciados en las personas diagnosticadas antes de los 10 años. La quimioterapia no influyó en el riesgo de cáncer de tiroides ni modificó el efecto de la radioterapia.
Conclusiones:
- La reducción observada en el riesgo de cáncer de tiroides a dosis de radiación superiores a 30 Gy sugiere un efecto de muerte celular.
- La vigilancia a largo plazo para el cáncer de tiroides es crucial para los sobrevivientes de cáncer infantil que recibieron radioterapia en la cabeza, el cuello o el tórax, particularmente aquellos con antecedentes de linfoma de Hodgkin.
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