Increased incidence of parathyroid adenomas following X-ray treatment of benign diseases in the cervical spine in adult patients.

OBJECTIVE: To determine whether or not exposure to ionizing radiation as an adult increases the risk of developing parathyroid adenomas. DESIGN AND PATIENTS: A cohort of 27 415 patients had received X-ray treatment to palliate pain originating from arthrosis and spondylosis from 1950 to 1964. In a subcohort of 8144 patients the cervical spine was the target, or one of the targets for the treatment. With the technique used it could be assumed that, as a rule, the parathyroid glands had been included in the treated volume. Patients with parathyroid adenomas were obtained from the Swedish Cancer Register from 1958 to 1995. The standardized incidence ratio (SIR) was calculated. RESULTS: The number of person-years at risk was 180 492 in the cohort exposed at the cervical spine, and 412 994 in the control cohort irradiated only at other sites. The calculated dose in the parathyroid region in the study cohort was about 1 Gy. The observed number of parathyroid adenomas in the study cohort was 22, and 24 in the control cohort. Expected numbers based on population data were 12.0 and 24.7, respectively, giving an SIR of 1.83 (95% CI 1.14-2.76) and 0.97 (CI 0.62-1.45), respectively. Mean age at exposure was 48.9 years (SD 10.2) and at diagnosis 71.5 years (SD 8.3). The time from exposure to diagnosis varied from 2 to 34 years (median 26 years). The excess relative risk was about 0.8 per Gy. CONCLUSION: Exposure to ionizing radiation to the cervical spine in adult age seems to be associated with an increased risk of developing parathyroid adenomas.

A cohort study with regard to the risk of haematological malignancies in patients treated with x-rays for benign lesions in the locomotor system. I. Epidemiological analyses.

Roentgen treatment for painful benign conditions in the locomotor system as arthrosis and spondylosis was in Sweden very common up to the beginning of the 1960s. The mode of treatment differed from the British ankylosing spondylitis series as smaller parts of the red bone marrow were exposed and smaller doses were applied. A cohort of 20,024 such patients treated 1950-1964 at two hospitals in northern Sweden was analysed with regard to the risk of haematological malignancies. Average factors for conversion of prescribed skin doses to mean absorbed red bone marrow doses were estimated on random samples of the different treatment sites and then applied on the cohort in its whole. The standard incidence ratio (SIR) for leukaemia was 1.18 (95% CI: 0.98-1.42) and the standard mortality ratio (SMR) 1.25 (0.99-1.45). In the highest dose group (mean absorbed red bone marrow dose > 0.5 Gy) the corresponding values were 1.40 (1.00-1.92) and 1.50 (1.08-2.04). In the mortality analysis also a slightly increased myeloma risk was noted with SMR = 1.20 (0.99-1.56). Extension of the cohort and nested case-control studies are under progress.

An assessment of the risk of developing hyperparathyroidism and thyroid disorders subsequent to neck irradiation in middle-aged women.

We investigated the occurrence of thyroid and parathyroid disorders in 100 women (age 66-70 years) irradiated for cervical spondylosis on average 25 years previously and in 100 control women of similar age. Hyperparathyroidism (HPT), proven by operation, was diagnosed in one patient of each group, and three additional cases were diagnosed biochemically among irradiated women. The difference in incidence is not significant. Nor was there any significant difference in incidence of thyroid disorders. No thyroid carcinoma was found in either group. Even if there is a moderate increase of HPT after neck irradiation in middle-aged women the risk is not so great as to warrant organised follow-up.

[Radiotherapy in degenerative-dystrophic and inflammatory diseases of the osteoarticular system]. / Luchevaia terapiia pri degenerativno-distroficheskikh i vospalitel'nykh zabolevanniakh kostno-sustavnoi sistemy.

Analysis of a 3-6-year follow-up of 565 patients with deforming arthrosis, spondylosis, osteochondrosis, spondylarthrosis and calcareous bursitis indicates the efficacy of the proposed standardized complex of topometric and roentgenotherapeutic methods. Medical and social rehabilitation was achieved in most of the patients. The quantitative assessment of the therapeutic results makes it possible to interpret them objectively and unambiguously.

The value of roentgen irradiation in the treatment of painful degenerative and inflammatory musculoskeletal conditions. A double-blind study.

A double-blind trial was carried out to study the effect of roentgen radiation treatment in 104 patients presenting 127 painful disorders of the joints and muscles. 64 disorders received genuine treatment and 63 had sham treatment. Improvement occurred in 59% of the genuinely treated group and in 65% of the placebo group. The results were about the same 2 weeks and 6 weeks after termination of treatment. Thus there was no significant difference between the groups.