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Strahlentherapie und Onkologie

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01-06-2020 | Radiotherapy | Original Article

Model-based calculation of thyroid gland normal tissue complication probability in head and neck cancer patients after radiation therapy

Authors: Ivana Kinclová, Eva Hajtmanová, Pavol Matula, Soňa Balentová, Peter Muríň, Marián Ďuroška, Katarína Kozlíková

Published in: Strahlentherapie und Onkologie | Issue 6/2020

Abstract

Aim

Primary hypothyroidism is one of the late complications that can occur after radiation therapy for malignant tumors in the head and neck region. The aim of this retrospective study was to show the validity of the Lyman–Kutcher–Burman (LKB) normal tissue complication model for thyroid gland based on clinical results.

Methods

Thyroid function was evaluated by measuring thyroid-stimulating hormone and free thyroxine serum levels before radiation therapy, 3 months after the beginning of radiation therapy, and afterwards at each follow-up visit. Cumulative incidence was calculated using the Kaplan–Meier method. Dose–volume histogram, total dose, fractionation schedule, total duration of the treatment, and other parameters were used for normal tissue complication probability calculation based on the LKB model. The model was evaluated after fitting with the three sets of parameters for grade 2 hypothyroidism: 1) “Emami,” where n = 0.22; m = 0.26, and D₅₀ = 80 Gy; 2) “mean dose,” where n = 1; m = 0.27, and D₅₀ = 60 Gy; and 3) “Lyman EUD,” where n = 0.49; m = 0.24, and D₅₀ = 60 Gy. A value 3.0 Gy was used for α/β ratio

Results

Eighty-three patients treated with volumetric modulated arc therapy for head and neck cancers at the University Hospital Martin, Slovakia, from January 2014 to July 2017, were included in the retrospective study. Median follow-up was 1.2 years. Cumulative incidence of hypothyroidism grade 2 or higher after 12 and 24 months was 9.6 and 22.0%, respectively. Normal tissue complication probability values calculated with mean dose and Lyman EUD parameters showed the best correlation with our clinical findings.

Conclusion

Empirically based modelling of normal tissue complication probability was valid for our cohort of patients. With carefully chosen parameters, the LKB model can be used for predicting the normal tissue complication probability value.

Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492 CrossRef

Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ (1997) Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 82:771–776. https://doi.org/10.1210/jcem.82.3.3810 CrossRefPubMed

Jereczek-Fossa BA, Alterio D, Jassem J et al (2004) Radiotherapy induced treatment disorders. Cancer Treat Rev 30:369–384. https://doi.org/10.1016/j.ctrv.2003.12.003 CrossRefPubMed

Miller M, Agrawal A (2009) Hypothyroidism in post radiation head and neck cancer patients: Incidence, complications and management. Curr Opin Otolaryngol Head Neck Surg 2009(17):111–115. https://doi.org/10.1097/MOO.0b013e328325a538 CrossRef

Boomsma MJ, Bijl HP, Langendijk JA (2011) Radiation-induced hypothyroidism in head and neck cancer patients: a systematic review. Radiother Oncol 99(1):1–5. https://doi.org/10.1016/j.radonc.2011.03.002 CrossRefPubMed

Sommat K, Ong WS, Hussain A, Soong YL, Tan T, Wee J, Fong KW (2017) Thyroid V40 predicts primary hypothyroidism following intensity modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 98(3):574–580. https://doi.org/10.1016/j.ijrobp.2017.03.007 CrossRefPubMed

Marks LB, Ten Haken RK, Martel MK (2010) Guest editor’s introduction to QUANTEC: a users guide. Int J Radiat Oncol Biol Phys 76(3 Suppl):S1–S2. https://doi.org/10.1016/j.ijrobp.2009.08.075 CrossRefPubMed

Luxton G, Hancock SL, Boyer AL (2004) Dosimetry and radiobiologic model comparison of IMRT and 3D conformal RT in treatment of carcinoma of the prostate. Int J Radiat Oncol Biol Phys 59(1):267–284. https://doi.org/10.1016/j.ijrobp.2004.01.024 CrossRefPubMed

ICRU (International Commission on Radiation Units and Measurements) (2010) Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). ICRU Report 83. J ICRU. https://doi.org/10.1093/jicru/ndq002 CrossRef

10.

Halperin EC, Wazer DE, Perez CA, Brady LW (eds) (2018) Perez and Brady’s principles and practice of radiation oncology, 7th edn. Wolters Kluwer, Philadelphia, p 809 (eISBN: 9781496386823)

11.

Lyman JT (1985) Complication probability as assessed from dose-volume histograms. Radiat Res 104(Suppl. 8):S13–S19. https://doi.org/10.2307/3576626 CrossRef

12.

Kutcher GJ, Burman C (1989) Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 16(6):1623–1630. https://doi.org/10.1016/0360-3016(89)90972-3 CrossRefPubMed

13.

Burman C, Kutcher GJ, Emami B, Goitein M (1991) Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys 21(1):123–135. https://doi.org/10.1016/0360-3016(91)90172-Z CrossRefPubMed

14.

Bakhshandeh M, Hashemi B, Mahdavi SRM, Nikoofar A, Vasheghani M, Kazemnejad A (2013) Normal tissue complication probability modeling of radiation-induced hypothyroidism after head-and-neck radiation therapy. Int J Radiat Oncol Biol Phys 85(2):514–521. https://doi.org/10.1016/j.ijrobp.2012.03.034 CrossRefPubMed

15.

National Cancer Institute Common terminology criteria for adverse events v5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. Accessed 15 Jan 2018

16.

National Cancer Institute Common toxicity criteria manual. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcmanual_v4_10-4-99.pdf. Accessed 15 Jan 2018

17.

IBM Corp (2015) IBM SPSS statistics for Windows, version 23.0. IBM Corp, Armonk

18.

Barendsen GW (1982) Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys 8(11):1981–1997. https://doi.org/10.1016/0360-3016(82)90459-x CrossRefPubMed

19.

Fowler JF (1983) Dose response curves for organ function or cell survival. Br J Radiol 56(667):497–500. https://doi.org/10.1259/0007-1285-56-667-497 CrossRefPubMed

20.

Lyman JT, Wolbarst AB (1987) Optimization of radiation therapy. III. A method of assessing complication probabilities from dose-volume histograms. Int J Radiat Oncol Biol Phys 8(7):90266–90265. https://doi.org/10.1016/0360-3016 CrossRef

21.

Lyman JT, Wolbarst AB (1989) Optimization of radiation therapy. IV. A dose-volume histogram reduction algorithms. Int J Radiat Oncol Biol Phys 17(2):433–436. https://doi.org/10.1016/0360-3016(89)90462-8 CrossRefPubMed

22.

Fowler JF, Harari PM, Leborgne F, Leborgne JH (2003) Acute radiation reactions in oral and pharyngeal mucosa: tolerable levels in altered fractionation schedules. Radiother Oncol 69(2):161–168. https://doi.org/10.1016/S0167-8140(03)00231-7 CrossRefPubMed

23.

Matula P, Koncik J (2018) Key to radiobiological modelling effects in radiation oncology. LAP LAMBERT Academic, Beau Basin, p 15

24.

BioGray http://www.q4space.netkosice.sk/. Accessed 15 Jan 2019

25.

Wei T, Simko V (2017) R package “corrplot”: visualization of a correlation matrix (version 0.84). https://github.com/taiyun/corrplot. Accessed 15 Jan 2019

26.

Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122. https://doi.org/10.1016/0360-3016(91)90171-Y CrossRefPubMed

27.

Bentzen SM, Constine LS, Deasy JO et al (2010) Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys 76(3, Suppl 1):S3–S9. https://doi.org/10.1016/j.ijrobp.2009.09.040 CrossRefPubMedPubMedCentral

28.

Boomsma MJ, Bijl HP, Christianen ME, Beetz I, Chouvalova O, Steenbakkers RJ, van der Laan BF, Wolffenbuttel BH, Oosting SF, Schilstra C, Langendijk JA (2012) A prospective cohort study on radiation-induced hypothyroidism: development of an NTCP model. Int J Radiat Oncol Biol Phys 84(3):e351–e356. https://doi.org/10.1016/j.ijrobp.2012.05.020 CrossRefPubMed

29.

Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB (2014) Thyroid V50 predicts hypothyroidism in head and neck cancer patients treated with IMRT. Int J Radiat Oncol Biol Phys 90(1):S549. https://doi.org/10.1016/j.ijrobp.2014.05.1666 CrossRef

30.

Dean JA, Wong KH, Welsh LC, Jones AJ, Schick U, Newbold KL, Bhide SA, Harrington KJ, Nutting CM, Gulliford S (2016) Normal tissue complication probability (NTCP) modelling using spatial dose metrics and machine learning methods for severe acute oral mucositis resulting from head and neck radiotherapy. Radiother Oncol 120(1):21–27. https://doi.org/10.1016/j.radonc.2016.05.015 CrossRefPubMedPubMedCentral

31.

Marks LB (1996) The impact of organ structure on radiation response. Int J Radiat Oncol Biol Phys 34:1165–1171. https://doi.org/10.1016/0360-3016(95)02186-8 CrossRefPubMed

32.

Marks LB, Yorke ED, Jackson A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76(3 Suppl):S10–S19. https://doi.org/10.1016/j.ijrobp.2009.07.1754 CrossRefPubMedPubMedCentral

33.

Vogelius IR, Bentzen SM, Maraldo MV, Petersen PM, Specht L (2011) Risk factors for radiation-induced hypothyroidism: a literature-based meta-analysis. Cancer 117(23):5250–5260. https://doi.org/10.1002/cncr.26186 CrossRefPubMed

34.

Feng M, Eisbruch A (2007) Future issues in highly conformal radiotherapy for head and neck cancer. J Clin Oncol 25(8):1009–1013. https://doi.org/10.1200/JCO.2006.10.4638 CrossRefPubMed

35.

Tribius S, Meyer MS, Pflug C et al (2018) Socioeconomic status and quality of life in patients with locally advanced head and neck cancer. Strahlenther Onkol 194:737–749. https://doi.org/10.1007/s00066-018-1305-3 CrossRef

Title: Model-based calculation of thyroid gland normal tissue complication probability in head and neck cancer patients after radiation therapy
Authors: Ivana Kinclová
Eva Hajtmanová
Pavol Matula
Soňa Balentová
Peter Muríň
Marián Ďuroška
Katarína Kozlíková
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Radiotherapy
Hypothyroidism
Published in: Strahlentherapie und Onkologie / Issue 6/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01579-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Model-based calculation of thyroid gland normal tissue complication probability in head and neck cancer patients after radiation therapy

Abstract

Aim

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

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Abstract

Aim

Methods

Results

Conclusion

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