Retrospective analysis finds thyroid cancer is a significant risk in pediatric brain tumor survivors post-radiotherapy, highlighting the need for increased vigilance.
Background/Introduction Cranial and craniospinal radiotherapy (RT) are common treatments for paediatric brain tumours but are associated with increased long-term risk of secondary cancers, such as thyroid cancer. This risk correlates with radiation dose and latency. Purpose This study describes thyroid cancer prevalence and features in this population. Methods Retrospective analysis of all paediatric brain tumour survivors followed in the endocrinology department of our centre between 1994 and 2022. Results Among 277 paediatric patients treated for brain tumours, thyroid nodules were found in 44 (15.9%). Of these, 13 (29.5%) developed thyroid cancer at a mean age of 28.3±6.2 years. Their previous diagnosis included medulloblastoma (n=8, 61.5%), ependymoma (n=2, 15.4%), and 1 case each (7.7%) of pineoblastoma, glioblastoma, and fibrillary astrocytoma. All 13 received RT: 10 (76.9%) craniospinal and 3 (23.1%) cranial only. Mean cranial RT dose was 52.0±2.1 Gy; craniospinal, 32.1±2.5 Gy. RT was administered at mean age of 6.4±3.3 years, with a mean latency period of 21.3±6.4 years until thyroid cancer diagnosis. Fine-needle aspiration cytology (FNAC) showed malignant findings in 1 case (7.7%), suspicious for malignancy in 2 (15.4%), follicular neoplasm in 1 (7.7%), atypia of undetermined significance in 4 (30.8%), and benign in 3 (23.1%). One FNAC identified a metastatic lymph node of papillary thyroid carcinoma (PTC). All patients underwent surgery: 11 (84.6%) had total thyroidectomy and 2 (15.4%) lobectomy. Surgery in benign cases was indicated due to nodule growth. Histology revealed PTC in 10 cases (76.9%) and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 3 (23.1%). Lymph node metastases were found in 4 patients (30.8%), and 1 (7.7%) developed pulmonary metastases and continues to have persistent structural disease. One patient (7.7%) has an indeterminate response, while the remaining 11 patients (84.6%) are currently disease-free. Conclusion(s) Thyroid cancer is a significant late complication in brain tumour survivors post-RT. Given their elevated risk, a high index of suspicion is necessary, and the threshold for surgery should be inferior for patients with indeterminate FNAC.
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Regala et al. (2025) studied this question.
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