Çocukluk Çağı Hodgkin Lenfoma Nedeniyle Tedavi Gören Hastalarda Tiroid Fonksiyonlarının Değerlendirilmesi

Abstract

Amaç: Çocukluk çağı Hodgkin Lenfoma tedavisinde sağkalım oran ve süresi uzadıkça, tedavi sonucu gelişen yan etkilerin görülme sıklığı artmakta ve tedavinin geç etkileri giderek önem kazanmaktadır. Bu çalışmada çocukluk çağında Hodgkin Lenfoma nedeniyle tedavi gören hastalarda, kemoterapi ve radyoterapinin tiroid fonksiyonları üzerine geç yan etkilerinin değerlendirilmesi amaçlandı. Yöntem: İstanbul Sağlık Bilimleri Üniversitesi, Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, Çocuk Hematoloji ve Onkoloji Kliniği’nde, 1994-2013 yılları arasında Hodgkin Lenfoma tanısı ile tedavi görüp, remisyonda olarak izlenen, en az 6 aydır tedavi almayan, 34’ü erkek, 6’sı kız olmak üzere toplam 40 hastanın tiroid fonksiyonları retrospektif olarak incelendi. Bulgular: Tanı alan hastaların yaş ortalaması 14.13±6.081 dağılım: 4-31 , erkek/kız oranı 34/6 %85/%15 idi. Ortalama takip süresi 5.54±3.68 yıl 0,92-13,92 idi. Tüm hastalara kemoterapi verildi. Boyun bölgesine radyoterapi 37 hasta %92,5 almıştı. Ortalama radyoterapi dozu 21.4875±4.48726 Gy idi. Hastalarımızda %72.5 oranında primer hastalık baş-boyun bölgesine lokalize idi. B semptomu 7 hastada %17,5 vardı. Kırk hastanın 12’inde %30 hasta hipotiroidi saptandı, 5 hastaya %41 klinik hipotiroidi tanısıyla replasman tedavisine başlandı. Bu hastaların 11’i erkek %91 , 1’i kızdı %9 . Hastalarımızın 5’inde %12.5 yapılan tiroid USG’sinde tiroid bezi nodülü saptandı. Tiroid nodülü saptanan toplam 5 hastanın 3’ü erkek %60 , 2’si kızdı %40 . Hipotiroidi gelişme zamanı 3.10±2.02 yıl, tiroid nodülü oluşma zamanı 8.90±7.10 yıl olarak saptandı. Tiroid sintigrafisi ve tiroid ultrasonografi sonuçlarına göre seçilen üç hasta tiroid biyopsisine yönlendirildi, malinite saptanmadı. Sonuç: Pediatrik Hodgkin Lenfoma hastalarında radyasyona bağlı tiroid hastalıkları, tedaviden sonraki yıllarda, hastalık remisyonda iken gelişebilir. Özellikle boyun radyoterapisine maruz kalmış hastalar, tiroid fonksiyon bozukluklarının ortaya çıkması açısından yakından takip edilmelidir

Keywords

• Hodgkin Lenfoma, çocukluk çağı, kemoterapi, tiroid, geç yan etki

Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma

Abstract

Objective: As the survival rate and duration increases in the treatment of childhood Hodgkin’s Lymphoma, the incidence of side effects resulting from the treatment increases and the late effects of the treatment become increasingly important. The aim of this study was to evaluate the late side effects of chemotherapy and radiotherapy on thyroid functions in patients treated for Hodgkin’s Lymphoma in childhood. Method: Thyroid functions of 40 patients who were treated with diagnosis of Hodgkin’s Lymphoma, between 1994 and 2013, followed up in remission in Istanbul Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Department of Pediatric Hematology and Oncology, were evaluated retrospectively. Results: The mean age of the patients was 14.13±6.081 range: 4-31 years, and the male / female ratio was 34/6 85%/15% . The mean follow-up period was 5.54±3.68 years 0.92-13.92 . All patients received chemotherapy. Thirty seven patients 92.5% received radiotherapy to the neck region. The mean radiotherapy dose was 21.4875±4.48726 Gy. Primary disease was localized to head and neck region in 72.5% of our patients. B symptoms were present in 7 patients 17.5% . Hypothyroidism was detected in 12 of 40 patients 30% and replacement therapy was started in 5 patients 41% with the diagnosis of clinical hypothyroidism. Eleven 91% of these patients were male and 1 9% was female. Thyroid gland nodules were detected in 5 12.5% of our patients. Of 5 patients with thyroid nodules, 3 were male 60% and 2 were female 40% . Hypothyroidism was 3.10±2.02 years and thyroid nodule was 8.90±7.10 years. Three patients who were selected according to thyroid scintigraphy and thyroid ultrasonography results were referred to thyroid biopsy and no malignancy was detected. Conclusion: Radiation-induced thyroid diseases in pediatric Hodgkin’s Lymphoma patients may develop during the years following treatment, when the disease is in remission. In particular, patients exposed to neck radiotherapy should be closely monitored for the occurrence of thyroid dysfunction.

Keywords

• Hodgkin’s Lymphoma, childhood, chemotherapy, thyroid, late side effect

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