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Radiation Oncology

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Open Access 01-12-2014 | Research

Dosimetric predictors of hypothyroidism in oropharyngeal cancer patients treated with intensity-modulated radiation therapy

Authors: Arthur Chyan, Josephine Chen, Erin Shugard, Louise Lambert, Jeanne M Quivey, Sue S Yom

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Radiation to the neck has long been associated with an elevated risk of hypothyroidism development. The goal of the present work is to define dosimetric predictors of hypothyroidism in oropharyngeal cancer (OPC) patients treated with intensity-modulated radiation therapy.

Methods

Data for 123 patients, with a median follow up of 4.6 years, were retrospectively analyzed. Patients with elevated thyroid-stimulating hormone levels or with a clinical diagnosis were categorized as hypothyroid. Patient demographic parameters, thyroid volume, mean thyroid dose, the percent of thyroid volume receiving minimum specified dose levels (VxxGy), and the absolute thyroid volume spared from specified dose levels (VSxxGy) were analyzed. Normal-tissue complication probability (NTCP) was also calculated using several recently published models.

Results

Thyroid volume and many radiation dosimetric parameters were statistically different in the hypothyroid group. For the patients with initial thyroid volumes of 8 cc or greater, several dosimetric parameters were found to define subgroups at statistically significant lower risk of developing hypothyroidism. Patients with VS45 Gy of at least 3 cc, VS50 Gy at least 5 cc, VS50 Gy at least 6 cc, V50 Gy below 45%, V50 Gy below 55%, or mean thyroid dose below 49 Gy had a 28-38% estimated risk of hypothyroidism at 3 years compared to a 55% risk for the entire study group. Patients with a NTCP of less than 0.75 or 0.8, calculated using recently published models, were also observed to have a lower risk of developing hypothyroidism.

Conclusions

Based on long-term follow up data for OPC patients treated with IMRT, we recommend plan optimization objectives to reduce the volume of thyroid receiving over 45 Gy to significantly decrease the risk of developing hypothyroidism.

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Hancock SL, Cox RS, McDougall IR: Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med. 1991, 325: 599-605. 10.1056/NEJM199108293250902.CrossRefPubMed

Weissler MC, Berry BW: Thyroid-stimulating hormone levels after radiotherapy and combined therapy for head and neck cancer. Head Neck. 1991, 13: 420-423. 10.1002/hed.2880130508.CrossRefPubMed

Grande C: Hypothyroidism following radiotherapy for head and neck cancer: multivariate analysis of risk factors. Radiother Oncol. 1992, 25: 31-36. 10.1016/0167-8140(92)90192-W.CrossRefPubMed

Kuten A, Lubochitski R, Fishman G, Dale J, Stein ME: Postradiotherapy hypothyroidism: radiation dose response and chemotherapeutic radiosensitization at less than 40 Gy. J Surg Oncol. 1996, 61: 281-283. 10.1002/(SICI)1096-9098(199604)61:4<281::AID-JSO10>3.0.CO;2-9.CrossRefPubMed

Tell R, Sjodin H, Lundell G, Lewin F, Lewensohn R: Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 1997, 39: 303-308. 10.1016/S0360-3016(97)00117-X.CrossRefPubMed

Vogelius IR, Bentzen SM, Maraldo MV, Petersen PM, Specht L: Risk factors for radiation-induced hypothyroidism: a literature-based meta-analysis. Cancer. 2011, 117: 5250-5260. 10.1002/cncr.26186.CrossRefPubMed

Bhandare N, Kennedy L, Malyapa RS, Morris CG, Mendenhall WM: Primary and central hypothyroidism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys. 2007, 68: 1131-1139. 10.1016/j.ijrobp.2007.01.029.CrossRefPubMed

Alterio D, Jereczek-Fossa BA, Franchi B, D'Onofrio A, Piazzi V, Rondi E, Ciocca M, Gibelli B, Grosso E, Tradati N, Mariani L, Boboc GI, Orecchia R: Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients. Int J Radiat Oncol Biol Phys. 2007, 67: 144-150. 10.1016/j.ijrobp.2006.08.051.CrossRefPubMed

Diaz R, Jaboin JJ, Morales-Paliza M, Koehler E, Phillips JG, Stinson S, Gilbert J, Chung CH, Murphy BA, Yarbrough WG, Murphy PB, Shyr Y, Cmelak AJ: Hypothyroidism as a consequence of intensity-modulated radiotherapy with concurrent taxane-based chemotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2010, 77: 468-476. 10.1016/j.ijrobp.2009.05.018.CrossRefPubMed

10.

Lin Z, Wu VW, Lin J, Feng H, Chen L: A longitudinal study on the radiation-induced thyroid gland changes after external beam radiotherapy of nasopharyngeal carcinoma. Thyroid. 2011, 21: 19-23. 10.1089/thy.2010.0229.CrossRefPubMed

11.

Johansen S, Reinertsen KV, Knutstad K, Olsen DR, Fossa SD: Dose distribution in the thyroid gland following radiation therapy of breast cancer – a retrospective study. Radiat Oncol 2011, 6:68.,

12.

Cella L, Conson M, Caterino M, De Rosa N, Liuzzi R, Picardi M, Grimaldi F, Solla R, Farella A, Salvatore M, Pacelli R: Thyroid V30 predicts radiation-induced hypothyroidism in patients treated with sequential chemo-radiotherapy for Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys. 2012, 82: 1802-1808. 10.1016/j.ijrobp.2010.09.054.CrossRefPubMed

13.

Cella L, Liuzzi R, Conson M, D'Avino V, Salvatore M, Pacelli R: Development of multivariate NTCP models for radiation-induced hypothyroidism: a comparative analysis. Radiat Oncol 2012, 7:224.,

14.

Boomsma MJ, Bijl HP, Christianen ME, Beetz I, Chouvalova O, Steenbakkers RJ, van der Laan BF, Wolffenbuttel BH, Oosting SF, Schilstra C, Langendijk JA: A prospective cohort study on radiation-induced hypothyroidism: development of an NTCP model. Int J Radiat Oncol Biol Phys. 2012, 84: e351-e356. 10.1016/j.ijrobp.2012.05.020.CrossRefPubMed

15.

Bakhshandeh M, Hashemi B, Mahdavi SR, Nikoofar A, Vasheghani M, Kazemnejad A: Normal tissue complication probability modeling of radiation-induced hypothyroidism after head-and-neck radiation therapy. Int J Radiat Oncol Biol Phys. 2013, 85: 514-521. 10.1016/j.ijrobp.2012.03.034.CrossRefPubMed

16.

Ronjom MF, Brink C, Bentzen SM, Hegedus L, Overgaard J, Johansen J: Hypothyroidism after primary radiotherapy for head and neck squamous cell carcinoma: Normal tissue complication probability modeling with latent time correction. Radiother Oncol. 2013, 109: 317-322. 10.1016/j.radonc.2013.06.029.CrossRefPubMed

17.

Fein DA, Hanlon AL, Corn BW, Curran WJ, Coia LR: The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin’s disease. Int J Radiat Oncol Biol Phys. 1996, 36: 13-18. 10.1016/S0360-3016(96)00249-0.CrossRefPubMed

Title: Dosimetric predictors of hypothyroidism in oropharyngeal cancer patients treated with intensity-modulated radiation therapy
Authors: Arthur Chyan
Josephine Chen
Erin Shugard
Louise Lambert
Jeanne M Quivey
Sue S Yom
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-014-0269-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dosimetric predictors of hypothyroidism in oropharyngeal cancer patients treated with intensity-modulated radiation therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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