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Shimizu H, Kodaira T, Kiyota N, Hayashi R, Nishino H, Asada Y, Mitani H, Hirayama Y, Onozawa Y, Nishio N, Hanai N, Ohkoshi A, Hara H, Monden N, Nagaoka M, Minami S, Fujii T, Tanaka K, Homma A, Yoshimoto S, Oridate N, Omori K, Ueda T, Okami K, Uemura H, Shiga K, Nakahira M, Asakage T, Saito Y, Sasaki K, Kitabayashi R, Ishikura S, Nishimura Y, Tahara M. Incidence and risk factors associated with the development of hypothyroidism after postoperative chemoradiotherapy for head and neck cancer patients with high-risk features: Supplementary analysis of JCOG1008. Oral Oncol 2024; 157:106976. [PMID: 39111143 DOI: 10.1016/j.oraloncology.2024.106976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND AND PURPOSE Hypothyroidism is a recognized late adverse event following radiotherapy for head and neck cancer (HNC). In the JCOG1008 trial, we treated patients with high-risk HNC with postoperative chemoradiotherapy. We aimed to elucidate factors associated with hypothyroidism by analyzing the JCOG1008 data. MATERIALS AND METHODS In 2012-2018, 261 patients from 28 institutions were enrolled in JCOG1008. Thyroid function tests were conducted to assess hypothyroidism, including free thyroxine (FT4) and thyroid-stimulating hormone assays. Hypothyroidism was defined as Grade 2 or higher in CTCAE v4.0. Various clinical and dosimetric parameters were analyzed. In radiotherapy, there were no dose constraints for the thyroid. Multivariable analysis was conducted on these variables to identify predictive factors for hypothyroidism. RESULTS The analysis included 162 patients (57 with 3D-CRT and 105 with IMRT), with a median follow-up of 4.7 years (0.3-9.3 years). Among these, 27 (16.7 %) developed hypothyroidism within 2 years after radiotherapy. In a multivariable analysis, the weekly cisplatin [OR=7.700 (CI: 1.632-36.343, p = 0.010)] and baseline FT4 [OR=0.009 (CI: <0.001-0.313, p = 0.010)] were significantly associated with hypothyroidism in the IMRT group. Regarding dosimetric characteristics, V60Gy [OR=1.069 (CI: 0.999-1.143, p = 0.054)] was potentially associated with the development of hypothyroidism. CONCLUSION The study revealed that the incidence of hypothyroidism within 2 years after postoperative chemoradiotherapy for high-risk HNC was 16.7 % based on analytical results from prospective clinical trials.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Cancer Center, Kobe, Japan.
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
| | - Hiroki Mitani
- Department of Head and Neck Oncology, Cancer Institute Hospital, Tokyo, Japan.
| | - Yuuji Hirayama
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan.
| | - Yusuke Onozawa
- Division of Clinical Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Hospital, Nagoya, Japan.
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Ina, Japan.
| | - Nobuya Monden
- Department of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
| | - Masato Nagaoka
- Department of Otolaryngology, Jikei University School of Medicine, Tokyo, Japan.
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan.
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Hospital, Osakasayama, Japan.
| | - Akihiro Homma
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan.
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Nobuhiko Oridate
- Department of Otolaryngology - Head and Neck Surgery, Yokohama City University Hospital, Yokohama, Japan.
| | - Koichi Omori
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan.
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan.
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan.
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University Hospital, Iwate, Japan.
| | - Mitsuhiko Nakahira
- Department of Head and Neck Surgery, Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Yuki Saito
- Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan.
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations office, National Cancer Center Hospital, Tokyo, Japan.
| | - Ryo Kitabayashi
- Japan Clinical Oncology Group Data Center/Operations office, National Cancer Center Hospital, Tokyo, Japan.
| | - Satoshi Ishikura
- Department of Radiation Oncology, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.
| | | | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.
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Quan KR, Lin WR, Hong JB, Lin YH, Chen KQ, Chen JH, Cheng PJ. A machine learning approach for predicting radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma undergoing tomotherapy. Sci Rep 2024; 14:8436. [PMID: 38600141 PMCID: PMC11006930 DOI: 10.1038/s41598-024-59249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
The purpose of this study was to establish an integrated predictive model that combines clinical features, DVH, radiomics, and dosiomics features to predict RIHT in patients receiving tomotherapy for nasopharyngeal carcinoma. Data from 219 patients with nasopharyngeal carcinoma were randomly divided into a training cohort (n = 175) and a test cohort (n = 44) in an 8:2 ratio. RIHT is defined as serum thyroid-stimulating hormone (TSH) greater than 5.6 μU/mL, with or without a decrease in free thyroxine (FT4). Clinical features, 27 DVH features, 107 radiomics features and 107 dosiomics features were extracted for each case and included in the model construction. The least absolute shrinkage and selection operator (LASSO) regression method was used to select the most relevant features. The eXtreme Gradient Boosting (XGBoost) was then employed to train separate models using the selected features from clinical, DVH, radiomics and dosiomics data. Finally, a combined model incorporating all features was developed. The models were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis. In the test cohort, the area under the receiver operating characteristic curve (AUC) for the clinical, DVH, radiomics, dosiomics and combined models were 0.798 (95% confidence interval [CI], 0.656-0.941), 0.673 (0.512-0.834), 0.714 (0.555-0.873), 0.698 (0.530-0.848) and 0.842 (0.724-0.960), respectively. The combined model exhibited higher AUC values compared to other models. The decision curve analysis demonstrated that the combined model had superior clinical utility within the threshold probability range of 1% to 79% when compared to the other models. This study has successfully developed a predictive model that combines multiple features. The performance of the combined model is superior to that of single-feature models, allowing for early prediction of RIHT in patients with nasopharyngeal carcinoma after tomotherapy.
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Affiliation(s)
- Ke-Run Quan
- Department of Radiation Oncology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Wen-Rong Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jia-Biao Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Yu-Hao Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Kai-Qiang Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Ji-Hong Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
| | - Pin-Jing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang, 421001, Hunan, China.
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Park YI, Cho MS, Chang JS, Kim JS, Kim YB, Lee IJ, Hong CS, Choi SH. Normal tissue complication probability models of hypothyroidism after radiotherapy for breast cancer. Clin Transl Radiat Oncol 2024; 45:100734. [PMID: 38317677 PMCID: PMC10839258 DOI: 10.1016/j.ctro.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose We aimed to develop Lyman-Kutcher-Burman (LKB) and multivariable normal tissue complication probability (NTCP) models to predict the risk of radiation-induced hypothyroidism (RIHT) in breast cancer patients. Materials and methods A total of 1,063 breast cancer patients who underwent whole breast irradiation between 2009 and 2016 were analyzed. Individual dose-volume histograms were used to generate LKB and multivariable logistic regression models. LKB model was fit using the thyroid radiation dose-volume parameters. A multivariable model was constructed to identify potential dosimetric and clinical parameters associated with RIHT. Internal validation was conducted using bootstrapping techniques, and model performance was evaluated using the area under the curve (AUC) and Hosmer-Lemeshow (HL) goodness-of-fit test. Results RIHT developed in 4 % of patients with a median follow-up of 77.7 months. LKB and multivariable NTCP models exhibited significant agreement between the predicted and observed results (HL P values > 0.05). The multivariable NTCP model outperformed the LKB model in predicting RIHT (AUC 0.62 vs. 0.54). In the multivariable model, systemic therapy, age, and percentage of thyroid volume receiving ≥ 10 Gy (V10) were significant prognostic factors for RIHT. The cumulative incidence of RIHT was significantly higher in patients who exceeded the cut-off values for all three risk predictors (systemic therapy, age ≥ 40 years, and thyroid V10 ≥ 26 %, P < 0.005). Conclusions Systemic therapy, age, and V10 of the thyroid were identified as strong risk factors for the development of RIHT. Our NTCP models provide valuable insights to clinicians for predicting and preventing hypothyroidism by identifying high-risk patients.
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Affiliation(s)
- Ye-In Park
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Seok Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi do, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- BC Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Wang C, Hou Y, Wang L, Yang Y, Li X. Analysis of correlative risk factors for radiation-induced hypothyroidism in head and neck tumors. BMC Cancer 2024; 24:5. [PMID: 38166748 PMCID: PMC10762937 DOI: 10.1186/s12885-023-11749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The aim of the study is to identify clinical and dosimetric factors that could predict the risk of radiation-induced hypothyroidism(RIHT) in head and neck cancer(HNC) patients following intensity-modulated radiotherapy(IMRT). METHODS A total of 103 HNC patients were included in our study. General clinical characteristic and dosimetric data of all recruited patients were analyzed, respectively. The univariate and multivariate logistic regression anlalysis were successively conducted to identify optimal predictors, which aim to construct the nomogram. And the joint prediction was performed. RESULTS The incidence of patients with HNC was 36.9% (38/103). Among the clinical factors, gender, N stage, chemotherapy, frequency of chemotherapy and surgery involving the thyroid were related to RIHT. Logistic regression analysis showed that thyroid volume, Dmean, VS45, VS50, VS60 and V30,60 were independent predictors of RIHT, which were also incorporated in the nomogram. An AUC of 0.937 (95%CI, 0.888-0.958) also was showed outstanding resolving ability of the nomogram. When the volume of the thyroid was greater than 10.6 cm3, the incidence of RIHT was 14.8%, and when the volume of the thyroid was equal to or smaller than 10.6 cm3, the incidence was 72.5%. The incidence rates of RIHT in the group with VS60≦8.4cm3 and VS60 > 8.4cm3 were 61.4% and 19.3%, respectively. CONCLUSIONS Thyroid volume and thyroid VS60 are independent predictors of RIHT in patients with HNC. Moreover, more attention should be paid to patients with thyroid volume ≤ 10.6cm3. Thyroid VS60 > 8.4cm3 may be a useful threshold for predicting the development of RIHT. The nomogram conducted by the research may become a potential and valuable tool that could individually predict the risk of RIHT for HNC patients.
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Affiliation(s)
- Chan Wang
- Department of Radiation Oncology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanjie Hou
- Department of Radiation Oncology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lili Wang
- Department of Radiation Oncology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ye Yang
- Department of Radiation Oncology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xianfeng Li
- Department of Radiation Oncology, The First Hospital of Shanxi Medical University, Taiyuan, China.
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Gade V, Bahl A, Rastogi A, Oinam A, Panda N, Ghoshal S. DOSIMETRIC AND EARLY CLINICAL OUTCOMES OF THYROID-SPARING VOLUMETRIC MODULATED ARC RADIOTHERAPY IN LOCALLY ADVANCED HEAD AND NECK CANCERS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2024; 20:59-64. [PMID: 39372295 PMCID: PMC11449247 DOI: 10.4183/aeb.2024.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Introduction Radiation-induced hypothyroidism is a well-recognized entity that occurs after an interval of 15-21 months. However, in the treatment of locally advanced Head and neck Squamous cell carcinoma (HNSCC), thyroid-sparing techniques are infrequently employed. Aims To evaluate the dosimetric and early clinical outcomes of thyroid-sparing SIB-VMAT technique (Simultaneous Integrated Boost - Volumetric Modulated Arc Radiotherapy) in patients of locally advanced HNSCC. Methods In this two-arm prospective pilot study, patients in the study group received radiotherapy by SIB-VMAT technique with a thyroid constraint to a dose of 70 Gy to the gross disease and 59.4 Gy to nodal and subclinical disease in 33 fractions over 6 ½ weeks with concurrent cisplatin. V50Gy<75% was the thyroid constraint used. The control group was treated with the same dose and technique but without using a thyroid gland constraint. The dose-volume parameters of the thyroid gland, PTV (Planning Target Volume) along with thyroid profile were analyzed. Results Twenty-six patients were recruited. Thyroid V50Gy of the study group (65.33 ±6.63 %) was significantly lower than that of control group (80.35 ±13.40 %) (p=0.003). Tumor dose parameters of both groups were compared and revealed no significant difference. At 18 months follow-up, the incidence of any degree of hypothyroidism was 46.15% in the study group and 23.07% in the control group (p=0.216). Conclusion In locally advanced HNSCC, it is feasible to spare the thyroid gland without compromising the tumour coverage. This has the potential to reduce the frequency of radiation-induced hypothyroidism.
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Affiliation(s)
- V.K.V. Gade
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. Bahl
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A.S. Oinam
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N.K. Panda
- Department of Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S. Ghoshal
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Tsai MH, Chang JTC, Lu HH, Wu YH, Pao TH, Cheng YJ, Zheng WY, Chou CY, Lin JH, Yu T, Chiang JH. Development and validation of a machine learning model of radiation-induced hypothyroidism with clinical and dose-volume features. Radiother Oncol 2023; 189:109911. [PMID: 37709053 DOI: 10.1016/j.radonc.2023.109911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/02/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND PURPOSE Radiation-induced hypothyroidism (RIHT) is a common but underestimated late effect in head and neck cancers. However, no consensus exists regarding risk prediction or dose constraints in RIHT. We aimed to develop a machine learning model for the accurate risk prediction of RIHT based on clinical and dose-volume features and to evaluate its performance internally and externally. MATERIALS AND METHODS We retrospectively searched two institutions for patients aged >20 years treated with definitive radiotherapy for nasopharyngeal or oropharyngeal cancer, and extracted their clinical information and dose-volume features. One was designated the developmental cohort, the other as the external validation cohort. We compared the performances of machine learning models with those of published normal tissue complication probability (NTCP) models. RESULTS The developmental and external validation cohorts consisted of 378 and 49 patients, respectively. The estimated cumulative incidence rates of grade ≥1 hypothyroidism were 53.5% and 61.3% in the developmental and external validation cohorts, respectively. Machine learning models outperformed traditional NTCP models by having lower Brier scores at every time point and a lower integrated Brier score, while demonstrating a comparable calibration index and mean area under the curve. Even simplified machine learning models using only thyroid features performed better than did traditional NTCP algorithms. The machine learning models showed consistent performance between folds. The performance in a previously unseen external validation cohort was comparable to that of the cross-validation. CONCLUSIONS Our model outperformed traditional NTCP models, with additional capabilities of predicting the RIHT risk at individual time points. A simplified model using only thyroid dose-volume features still outperforms traditional NTCP models and can be incorporated into future treatment planning systems for biological optimization.
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Affiliation(s)
- Mu-Hung Tsai
- Institute of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Joseph T C Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Hsi-Huei Lu
- Division of Nuclear Medicine, Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Medical Informatics, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Hua Wu
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Hui Pao
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Jen Cheng
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yen Zheng
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yu Chou
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Jing-Han Lin
- Division of Endocrinology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Hsien Chiang
- Institute of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan; Institute of Medical Informatics, National Cheng Kung University, Tainan, Taiwan.
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Pravesh K, Sethi P, Kamalanathan SK, Manavalan M. An Analytical Study to Determine Dose-Volume Threshold for Radiation Induced Hypothyroidism. Asian Pac J Cancer Prev 2023; 24:3859-3866. [PMID: 38019244 PMCID: PMC10772779 DOI: 10.31557/apjcp.2023.24.11.3859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023] Open
Abstract
Objective: To determine radiation dose volume threshold in predicting the development of hypothyroidism in cancer patients following neck irradiation. Methods: This is a cross sectional follow up study for patients who had been previously irradiated, prior to enrolment in the study. We have done thyroid dose-volumetric analysis on 120 histologically proven cancer patients in the age group of 18-75 years who received neck irradiation as a part of their definitive or adjuvant radiotherapy with three-dimensional conformal or intensity-modulated radiotherapy technique (3D -CRT or IMRT) and completed at least six months post-radiotherapy. Primary tumor sites included carcinoma or lymphoma of the head and neck, breast, cervical, and upper thoracic esophagus, requiring neck irradiation. Results: The proportion of patients who tested positive for Radiation induced hypothyroidism (RIHT) was found to be 40%, with clinical hypothyroidism and subclinical hypothyroidism being 25.8% and 14.2%, respectively. Time to develop hypothyroidism peaks around two years. Mean thyroid gland dose (Dmean) >28 Gy, thyroid gland volume receiving 40 Gy dose (i.e. V40) >49% and age <50 years were found to be significant risk factors for the development of RIHT on binary logistic regression. RT dose >50 Gy and thyroid gland volume spared from 40 Gy (i.e. VS40) < 2.12cm3 were statistically significant predictors for RIHT on chi-square and (Receiver operating characteristic) ROC curve analysis respectively but not on regression analysis. Conclusion: Dose-volume threshold for the thyroid gland as Dmean <28 Gy and V40 <49% may prevent the development of RIHT.
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Affiliation(s)
- Kumar Pravesh
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Pooja Sethi
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Sadish Kumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Manivannan Manavalan
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Rooney MK, Andring LM, Corrigan KL, Bernard V, Williamson TD, Fuller CD, Garden AS, Gunn B, Lee A, Moreno AC, Morrison WH, Phan J, Rosenthal DI, Spiotto M, Frank SJ. Hypothyroidism following Radiotherapy for Head and Neck Cancer: A Systematic Review of the Literature and Opportunities to Improve the Therapeutic Ratio. Cancers (Basel) 2023; 15:4321. [PMID: 37686597 PMCID: PMC10486996 DOI: 10.3390/cancers15174321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Radiotherapy (RT) is a central component for the treatment of many head and neck cancers. In this systematic review of the literature, we aimed to characterize and quantify the published evidence on RT-related hypothyroidism, including estimated incidence, clinical risk factors, and dosimetric parameters that may be used to guide clinical decision making. Furthermore, we aimed to identify potential areas of improvement in the prevention and clinical management of RT-induced hypothyroidism, including the role of modern advanced therapeutic techniques. (2) Methods: We conducted a systemic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed and Google Scholar were searched to identify original research articles describing the incidence, mechanism, dosimetry, treatment, or prevention of radiation-related hypothyroidism for adults receiving RT for the treatment of head and neck cancers. The snowball method was used to identify additional articles. For identified articles, we tabulated several datapoints, including publication date, patient sample size, estimated hypothyroidism incidence, cancer site/type, follow-up period, radiation modality and technique, use of multimodality therapy, method of thyroid function evaluation, and proposed dosimetric predictors of hypothyroidism. (3) Results: One hundred and eleven articles met inclusion criteria, reflecting a range of head and neck cancer subtypes. There was a large variation in the estimated incidence of RT-related hypothyroidism, with a median estimate of 36% (range 3% to 79%). Reported incidence increased in later publication dates, which was likely related to improved screening and longer follow up. There were a wide variety of predictive metrics used to identify patients at high risk of hypothyroidism, the most common of which were volumetric and mean dosimetrics related to the thyroid gland (Vxx%, Dmean). More recently, there has been increasing evidence to suggest that the thyroid gland volume itself and the volume of the thyroid gland spared from high-dose radiation (VSxx) may better predict thyroid function after RT. There were no identified studies investigating the role of advanced radiotherapeutic techniques such as MRI-guided RT or particle therapy to decrease RT-related hypothyroidism. Conclusions: Hypothyroidism is a common toxicity resulting from therapeutic radiation for head and neck cancer with recent estimates suggesting 40-50% of patients may experience hypothyroidism after treatment. Dosimetric predictive models are increasingly able to accurately identify patients at risk of hypothyroidism, especially those utilizing thyroid VS metrics. Further investigation regarding the potential for advanced radiotherapeutic therapies to decrease RT-induced thyroid dysfunction is needed.
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Affiliation(s)
- Michael K. Rooney
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA (V.B.); (T.D.W.); (S.J.F.)
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Karimijavid MR, Pashaki AS, Borzouei S, Khanlarzadeh E, Gholami MH, Nikzad S. Hypothyroidism Evaluation after Radiotherapy of Breast and Supraclavicular in Patients with Breast Cancer. Adv Biomed Res 2023; 12:44. [PMID: 37057230 PMCID: PMC10086662 DOI: 10.4103/abr.abr_218_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 04/15/2023] Open
Abstract
Background This study aims to evaluate the risk of hypothyroidism (HT) after radiotherapy (RT) of breast and supraclavicular in patients with breast cancer (BC). Materials and Methods In a historical cohort study, the records of all patients with BC who had been referred to the Mahdieh radiotherapy Center of Hamadan from 2017 to 2019 were reviewed. Demographic characteristics, clinical information, previous and current used treatment methods (surgery, radiotherapy, chemotherapy), number of RT sessions and doses, and HT (TSH >5 mIU/L) were extracted from the patient's documents. Data were analyzed using SPSS software version 16. Results Out of 304 patients referred to the Center, 266 patients were investigated. The mean TSH was 6.3 ± 7.9 ml/L (1.5 to 65.4). Approximately half of the patients were in Stage 2 of the disease. 37 (16.4%) patients were diagnosed with HT, of which 8.8% were clinical, and 7.5% were subclinical. The mean total dose of HT patients (5621.62 ± 491.67) was significantly higher than other patients (5304.76 ± 937.98). 21 patients (56.8%) in Stage 3 and 4 and 16 (43.2%) patients in Stages 1 and 2 had HT (P = 0.006). Spearman correlation coefficient showed that there was a significant relationship between total dose and TSH hormone (r = 0.624), the number of RT sessions with TSH hormone (r = 0.237), and total dose with T4 hormone (r = -0.232). Conclusion The findings of this study showed that the risk of HT increases significantly in patients with BC who undergo RT of breast and supraclavicular. Patients with higher stage, more radiation, and more RT sessions are at higher risk of HT.
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Affiliation(s)
| | - Abdolazim S. Pashaki
- Department of Radiooncology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shiva Borzouei
- Clinical Research Development Unit, Shahid Beheshti Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Elham Khanlarzadeh
- Department of Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Safoora Nikzad
- Department of Medical Physics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Address for correspondence: Dr. Safoora Nikzad, Department of Medical Physics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
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Chow JCH, Lui JCF, Cheung KM, Tam AHP, Lam MHC, Yuen TYS, Lee FKH, Leung AKC, Au KH, Ng WT, Lee AWM, Kwan CK, Yiu HHY. Post-radiation primary hypothyroidism in patients with head and neck cancer: External validation of thyroid gland dose-volume constraints with long-term endocrine outcomes. Radiother Oncol 2022; 177:105-110. [PMID: 36336109 DOI: 10.1016/j.radonc.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Post-radiation primary hypothyroidism is a common late complication in head and neck cancer (HNC) survivors. No radiation dose-volume constraint of the thyroid gland has been externally validated for predicting long-term thyroid function outcomes. MATERIALS AND METHODS This external validation study evaluated the diagnostic properties of 22 radiation dose-volume constraints of the thyroid gland proposed in the literature. Radiation dosimetric data from 488 HNC patients who underwent neck irradiation from January 2013 to December 2015 at two tertiary oncology centers were reviewed. The diagnostic metrics of candidate constraints were computed by inverse probability of censoring weighting and compared using time-dependent receiver operating characteristic (ROC) curves with death designated as a competing event. Multivariable regression analyses were performed using the Fine-Gray sub-distribution hazard model. RESULTS Over a median follow-up period of 6.8 years, 205 (42.0 %) patients developed post-radiation primary hypothyroidism. The thyroid volume spared from 60 Gy (VS60) had the largest area under ROC curve of 0.698 at 5 years after radiotherapy. Of all evaluated constraints, VS60 at a cutoff value of 10 cc had the highest F-score of 0.53. The 5-year hypothyroidism risks of patients with thyroid VS60 ≥ 10 cc and < 10 cc were 14.7 % and 38.2 %, respectively (p < 0.001). The adjusted sub-hazard ratio for post-radiation primary hypothyroidism for VS60 < 10 cc was 1.87 (95 % confidence interval, 1.22-2.87; p < 0.001). CONCLUSION Thyroid VS60 is the best radiation dose-volume parameter to predict the long-term risk of primary hypothyroidism in patients with HNC who underwent neck irradiation. VS60 ≥ 10 cc is a robust constraint that limits the 5-year primary hypothyroidism risk to less than 15 % and should be routinely employed during radiotherapy optimization.
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Affiliation(s)
- James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.
| | - Jeffrey C F Lui
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Ka-Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Anthony H P Tam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Martin H C Lam
- Department of Oncology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Tony Y S Yuen
- Department of Oncology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Francis K H Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Alex K C Leung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Wai-Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region, China
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chung-Kong Kwan
- Department of Oncology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Harry H Y Yiu
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
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11
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Pal SK, Das S, Isiah R, John S. Determining the Occurrence of Hypothyroidism Following Treatment With Radiation Therapy in Head and Neck Carcinoma Patients and the Associated Role of Risk Factors and Dose-Volume Histograms: A Prospective Study. Cureus 2022; 14:e31590. [PMID: 36408306 PMCID: PMC9672115 DOI: 10.7759/cureus.31590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Head and neck carcinomas are one of the most common malignancies in developing countries including India. Most patients are treated with radiotherapy. Although post-radiotherapy hypothyroidism is a known complication, data regarding its incidence and factors influencing it are scarce. This study aimed to determine the incidence of post-radiotherapy hypothyroidism in head and neck carcinoma patients treated with radiotherapy and the factors influencing it. Methodology Patients with head and neck carcinomas treated with radiotherapy as one of the modalities were included in this study. Thyroid function tests were done, and quality of life questionnaires were completed before treatment and during follow-up. Dose-volume histogram (DVH), demographic data, and disease-related parameters were compared. Results Out of the 95 patients screened, 14 were found to be hypothyroid prior to the commencement of radiotherapy and were excluded. With a median follow-up duration of 34 weeks, 29.6% developed hypothyroidism, with 19% developing it in the first year. On univariate and multivariate analysis of the DVH of the thyroid gland, volume receiving 50 Gy (V50), dose received to 50% volume (D50), and the mean dose (more than 50 Gy) were found to be significantly associated with hypothyroidism. Conclusions Hypothyroidism is a significant comorbid factor in Indian patients with head and neck carcinomas. The incidence of post-radiotherapy hypothyroidism is significant and occurs early compared to the western population leading to significant deterioration in the quality of life. Parameters such as the volume of the thyroid gland, V50, D50, and mean dose to the thyroid gland influence the incidence of hypothyroidism. The use of appropriate constraints can significantly prevent radiotherapy-induced hypothyroidism.
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12
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Chow JC, Cheung KM, Cheung GT, Tam AH, Lui JC, Lee FK, Au KH, Ng WT, Lee AW, Yiu HH. Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: a systematic review. Clin Transl Radiat Oncol 2022; 33:83-92. [PMID: 35128087 PMCID: PMC8807951 DOI: 10.1016/j.ctro.2022.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 12/09/2022] Open
Abstract
This systematic review included 29 studies (n = 4,530 patients) on dosimetric predictors of primary hypothyroidism in HNC. Average crude incidence of primary hypothyroidism after HNC radiotherapy was 41.4%. Thyroid Dmean and V50 were the most widely reported dosimetric predictors for hypothyroidism. Thyroid volume is a predictor of hypothyroidism (pooled aOR 0.89 per 1 cc increment) independent of radiation dosimetry. Thyroid gland constraints individualized for thyroid volume are crucial in HNC radiotherapy.
Background and Purpose This systematic review aims to identify radiation dose-volume predictors of primary hypothyroidism after radiotherapy in patients with head and neck cancer (HNC). Materials and methods We performed a systematic literature search of Medline, EMBASE and Web of Science from database inception to July 1, 2021 for articles that discuss radiation dose-volume predictors of post-radiation primary hypothyroidism in patients with HNC. Data on the incidence, clinical risk factors and radiation dose-volume parameters were extracted. A meta-analysis was performed using the random-effects model to estimate the pooled odds ratio (OR) of thyroid volume as a predictor of the risk of post-radiation hypothyroidism, adjusted for thyroid radiation dosimetry. Results Our search identified 29 observational studies involving 4,530 patients. With median follow-up durations ranging from 1.0 to 5.3 years, the average crude incidence of post-radiation primary hypothyroidism was 41.4 % (range, 10 %–57 %). Multiple radiation dose-volume parameters were associated with post-radiation primary hypothyroidism, including the thyroid mean dose (Dmean), minimum dose, V25, V30, V35, V45, V50, V30–60, VS45 and VS60. Thyroid Dmean and V50 were the most frequently proposed dosimetric predictors. The pooled adjusted OR of thyroid volume on the risk of post-radiation primary hypothyroidism was 0.89 (95 % confidence interval, 0.85–0.93; p < 0.001) per 1 cc increment. Conclusion Post-radiation primary hypothyroidism is a common late complication after radiotherapy for HNC. Minimizing inadvertent exposure of the thyroid gland to radiation is crucial to prevent this late complication. Radiation dose-volume constraints individualized for thyroid volume should be considered in HNC radiotherapy planning.
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13
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Mireștean CC, Iancu RI, Iancu DPT. An Underestimated Toxicity Radiation-Induced Hypothyroidism in Patients Multimodally Treated for Breast Cancer. J Clin Med 2021; 10:jcm10235503. [PMID: 34884204 PMCID: PMC8658069 DOI: 10.3390/jcm10235503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Radiation therapy is part of the therapeutic arsenal for breast cancer, whether it is adjuvant treatment after lumpectomy or radical mastectomy, or it is used as a palliative option in the case of metastatic or recurrent disease. Significant advances in diagnostic and therapeutic stratification of breast cancers have significantly prolonged survival, even in the metastatic stage. Exposure of patients during the course of the disease in a multidisciplinary therapeutic approach including chemotherapy, hormone therapy, targeted anti-HER therapies or CDK4/6 inhibitors had led to improved survival but with the price of additional toxicity. Among them, hypothyroidism is a well-known consequence of external radiation therapy, especially in the case of cervical region irradiation, including supraclavicular and infra-clavicular nodal levels. In this situation, the thyroid gland is considered as an organ at risk (OAR) and receives a significant dose of radiation. Subclinical hypothyroidism is a common endocrine disorder characterized by elevated TSH levels with normal levels of FT4 (free T4) and FT3 (free T3), and as a late effect, primary hypothyroidism is one of the late effects that significantly affects the quality of life for patients with breast cancer receiving multimodal treatment. Hypothyroidism has a significant impact on quality of life, most often occurring as late clinical toxicity, secondary to thyroid irradiation at doses between 30 and 70 Gy. Dose-volume parameters of irradiation, gland function at the beginning of the treatment and associated systemic therapies may be factors that alter thyroid radio-sensitivity and affect thyroid gland tolerance. In the case of head and neck tumor pathology, in which doses of >50 Gy are routinely used, the thyroid gland is generally considered as an OAR, the rate of radio-induced hypothyroidism being estimated at rates of between 20% and 52%. For breast cancer, the thyroid is often neglected in terms of dosimetry protection, the rate of late dysfunction being 6–21%.
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Affiliation(s)
- Camil Ciprian Mireștean
- Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Department of Surgery, Railways Clinical Hospital Iasi, 700506 Iași, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Faculty of Dental Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Clinical Laboratory, “St. Spiridon” Emergency Universitary Hospital, 700111 Iași, Romania
- Correspondence: ; Tel.: +40-232-301-603
| | - Dragoș Petru Teodor Iancu
- Oncology and Radiotherapy Department, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iași, Romania
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14
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Shen G, Peng Y, Li J, Wu H, Zhang G, Zhao C, Deng X. Multivariate NTCP Model of Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma. Front Oncol 2021; 11:714536. [PMID: 34504792 PMCID: PMC8421234 DOI: 10.3389/fonc.2021.714536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the incidence of hypothyroidism in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT), analyze its correlation with multiple influencing factors such as thyroid exposure dose, thyroid volume, and gender, and construct a multivariate-based normal tissue complication probability (NTCP) model for the occurrence of hypothyroidism after IMRT. Materials and Methods The thyroid hormone levels of patients at different points in time before and after radiotherapy were tested, and statistics on the incidence of hypothyroidism after treatment were obtained. The dose-volume data of patients’ thyroids were converted into EQD2 equivalent dose values. The correlation between hypothyroidism after radiotherapy and thyroid exposure dose, thyroid volume, gender, and other factors was analyzed, and an NTCP model was constructed. Results A total of 69 patients with nasopharyngeal carcinoma were enrolled in this study. Twelve months after radiotherapy, a total of 24 patients (34.8%) developed hypothyroidism. Univariate analysis and multivariate analysis revealed that the average thyroid dose and thyroid volume are the most important factors affecting hypothyroidism after radiotherapy. The NTCP model constructed based on the average dose and thyroid volume has a good degree of fit. Conclusion The volume and average dose of the thyroid gland are the key factors affecting the occurrence of hypothyroidism in patients with nasopharyngeal carcinoma after radiotherapy. The NTCP model constructed based on multivariate construction suggests that reducing the average dose of the thyroid to the greatest extent is an effective way to protect thyroid functions.
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Affiliation(s)
- Guanzhu Shen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinglin Peng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Jian Li
- Department of Radiation Oncology, Central Hospital of Guangdong Nongken, Zhanjiang, China
| | - Haijun Wu
- Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan, Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, China
| | - Guangshun Zhang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chong Zhao
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaowu Deng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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15
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Choi SH, Chang JS, Byun HK, Son NH, Hong CS, Hong N, Park Ms YI, Kim J, Kim JS, Kim YB. Risk of Hypothyroidism in Women After Radiation Therapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 110:462-472. [PMID: 33412261 DOI: 10.1016/j.ijrobp.2020.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the hypothyroidism risk after adjuvant radiation therapy (RT) and the association of different RT targets with hypothyroidism risk. METHODS We studied 4073 women treated with adjuvant RT for breast cancer from 2007 to 2016. The primary endpoint was hypothyroidism development after RT. Patients were divided and analyzed into 3 groups: whole breast (WB)-alone (n = 2468), regional node irradiation (RNI)-Lv.4 (n = 215; cranial border at the subclavian artery, according to the European Society for Radiotherapy and Oncology consensus guideline), and RNI-supraclavicular lymph node (SCL) (n = 1390; cranial border at the cricoid cartilage). In general, RNI-Lv.4 was used in the patients with high-risk pN0 and pN1 breast cancer. In auxiliary analysis, the mean thyroid dose was estimated in each group (total n = 600, 200 from each group). All the doses were converted to the equivalent dose in 2 Gy fractions (EQD2) with α/β ratios of 3. RESULTS The median follow-up duration was 84 months (WB-alone, 84 months; RNI-Lv.4, 44 months; RNI-SCL, 91 months). The 3-year hypothyroidism incidence rate differed significantly between the RNI-SCL and WB-alone groups (2.2% vs 0.8%; Bonferroni corrected P [Pc] < .001) but not between the RNI-Lv.4 and WB-alone groups (0.9% vs 0.8%; Pc > .05). The Cox model revealed an adjusted hazard ratio of 2.25 (95% CI, 1.49-3.38) for RNI-SCL vs WB-alone, 1.69 (95% CI, 1.12-2.56) for adjuvant systemic therapies, and 2.07 (95% CI, 1.07-3.99) for age <60 years. In the subgroup analysis, the hypothyroidism risk became more prominent in patients aged <60 years. The mean exposure doses to the thyroid were 0.23 versus 1.93 versus 7.89 Gy (EQD2) for the WB-alone versus RNI-Lv.4 versus RNI-SCL groups (P < .001). No statistically different locoregional recurrence rates were seen between groups (5-year rate: <3%). CONCLUSIONS The risk of hypothyroidism increases after RNI-SCL for breast cancer but not after RNI-Lv 4. These data support routine contouring of the thyroid in the RNI setting, and future studies are required to develop optimal dose-volume constraints.
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Affiliation(s)
- Seo Hee Choi
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
| | - Hwa Kyung Byun
- Data Science Team, Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Nak-Hoon Son
- Data Science Team, Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ye-In Park Ms
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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16
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Leddon JL, Chirra M, Frankart AJ, Agrawal A, Roof L, Trotier D, Shaikh H, Stone T, Jandarov R, Takiar V, Wise-Draper TM. Hypothyroidism in Head and Neck Squamous Cell Carcinoma Patients Receiving Radiotherapy With or Without Immune Checkpoint Inhibitors. Laryngoscope 2021; 131:E2413-E2419. [PMID: 33609046 DOI: 10.1002/lary.29451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Hypothyroidism is a relatively common complication of head and neck squamous cell carcinoma (HNSCC) treatment. The objective of this study was to determine whether the addition of programmed death ligand-1 (PD-1) or programmed death ligand-1 (PD-L1) inhibition (anti-PD-1/PD-L1 therapy) to standard treatment increases the risk of hypothyroidism in HNSCC. STUDY DESIGN Retrospective Cohort. METHODS This is a retrospective, single institutional cohort study. Patients who received radiotherapy (RT) for HNSCC were identified in the electronic medical record. Patient factors collected include age, sex, body mass index (BMI), smoking status, alcohol use, Charlson comorbidity index, and HNSCC treatment records. The rate of hypothyroidism for patients with HNSCC receiving RT (+/- chemotherapy and surgery) (RT group, n = 101) was compared to that of HNSCC patients receiving RT (+/- chemotherapy and surgery) + anti-PD-1/PD-L1 therapy, either concurrently or after RT (RT + anti-PD-1/PD-L1 group, n = 38). RESULTS There was no significant difference in the rate of clinical or subclinical hypothyroidism between the two groups. Multinomial logistic regression found no significant difference in hypothyroidism based on age, sex, or BMI. CONCLUSIONS The addition of anti-PD-1/PD-L1 therapy to standard HNSCC treatment does not significantly increase the risk of developing hypothyroidism. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2413-E2419, 2021.
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Affiliation(s)
- Jennifer L Leddon
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A.,Department of Internal Medicine, Clinical Scientist Training Program, University of Cincinnati, Cincinnati, OH, U.S.A
| | - Martina Chirra
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A.,Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, U.S.A
| | - Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
| | - Arushi Agrawal
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
| | - Logan Roof
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
| | - Danny Trotier
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
| | - Hira Shaikh
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
| | - Timothy Stone
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, U.S.A
| | - Roman Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, U.S.A
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A.,Department of Radiation Oncology, Cincinnati VA Medical Center, Cincinnati, OH, U.S.A
| | - Trisha M Wise-Draper
- Division of Hematology Oncology, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, U.S.A
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Zhou L, Chen J, Tao CJ, Chen M, Yu ZH, Chen YY. Research progress of radiation-induced hypothyroidism in head and neck cancer. J Cancer 2021; 12:451-459. [PMID: 33391441 PMCID: PMC7738994 DOI: 10.7150/jca.48587] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022] Open
Abstract
This paper reviews the factors related to hypothyroidism after radiotherapy in patients with head and neck cancer to facilitate the prevention of radiation-induced hypothyroidism and reduce its incidence. Hypothyroidism is a common complication after radiotherapy in patients with head and neck cancer, wherein the higher the radiation dose to the thyroid and pituitary gland, the higher the incidence of hypothyroidism. With prolonged follow-up time, the incidence of hypothyroidism gradually increases. Intensity modulated radiotherapy should limit the dose to the thyroid, which would reduce the incidence of hypothyroidism. In addition, the risk factors for hypothyroidism include small thyroid volume size, female sex, and previous neck surgery. The incidence of radiation-induced hypothyroidism in head and neck cancer is related to the radiation dose, radiotherapy technique, thyroid volume, sex, and age. A prospective, large sample and long-term follow-up study should be carried out to establish a model of normal tissue complications that are likely to be related to radiation-induced hypothyroidism.
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Affiliation(s)
- Ling Zhou
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong 524000, China
| | - Jia Chen
- Medical Research Institute, Hangzhou YITU Healthcare Technology Co., Ltd, Hangzhou, Zhejiang 330106, China.,Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai 200050, China
| | - Chang-Juan Tao
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Ming Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Zhong-Hua Yu
- Department of Oncology, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524001, China
| | - Yuan-Yuan Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
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Peng L, Mao YP, Huang CL, Guo R, Ma J, Wen WP, Tang LL. A New Model for Predicting Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma. Front Oncol 2020; 10:551255. [PMID: 33102218 PMCID: PMC7546200 DOI: 10.3389/fonc.2020.551255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives To develop a model that can predict the risk of hypothyroidism (HT) after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC), and to accordingly recommend dose constraints. Materials and Methods NPC patients treated between 2011 and 2015 were retrospectively reviewed. HT was defined by an abnormally high level of thyrotropin. The dosimetry parameters Vx (percentage of thyroid volume receiving more than x Gy of radiation) and Va,b (percentage of thyroid volume receiving >a Gy, while ≤b Gy radiation) were calculated. The primary endpoint was the development of HT within the first 2 years after IMRT. The least absolute shrinkage and selection operator and multivariate logistic regression were used to identify predictors of HT. Results A total of 545 patients were included in the analyses, with a median follow-up of 36 months. Of the 545 patients, 138 developed HT within 2 years, and the 2-year incidence of HT was 25.3%. In patients with thyroid volume >20 cm3, the 2-year incidence of HT was 11.7% (16/137); in patients with thyroid volume ≤20 cm3 and V30,60 ≤ 80%, the 2-year HT incidence was 19.9% (33/166); in patients with thyroid volume ≤20 cm3 and V30,60 > 80%, the 2-year incidence of HT was 36.8% (89/242). Conclusion Thyroid volume and V30,60 could be reliable predictors of HT after IMRT for NPC. For patients with thyroid volume ≤20 cm3, thyroid V30,60 ≤ 80% might be a useful dose constraint to adopt during IMRT planning.
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Affiliation(s)
- Liang Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Cheng-Long Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Ping Wen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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Huang H, Roberson J, Hou W, Mani K, Valentine E, Ryu S, Stessin A. NTCP model for hypothyroidism after supraclavicular-directed radiation therapy for breast cancer. Radiother Oncol 2020; 154:87-92. [PMID: 32926911 DOI: 10.1016/j.radonc.2020.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Hypothyroidism (HT) is a well-known complication of radiation (RT) that includes supraclavicular (SCV) fields. We analyzed breast cancer patients who received SCV-directed RT to evaluate predictors of HT and developed the first normal tissue complication probability (NTCP) model for HT specific to breast cancer patients. MATERIALS AND METHODS 192 breast cancer patients received SCV-directed RT between 2007 and 2019 and met inclusion criteria. Individual dose-volume histograms were analyzed to determine thyroid volume within and outside specific isodose lines as well as minimum, mean, and maximum doses. Multivariable logistic regression was performed to assess potential clinical and treatment factors for the development of hypothyroidism. An NTCP model was created, and model validation was performed. RESULTS Thirty-seven patients (19.3%) developed HT following SCV-directed RT at a median 25 months (range: 2-83 months). Multivariable analysis revealed longer length of follow-up (p = 0.015) and larger thyroid volume receiving less than 20 Gy (CV20Gy[cc]; p = 0.045) were significant prognostic factors (p = 0.039). IMRT was not associated with an increased risk of hypothyroidism (p = 0.28) despite lower CV20Gy[cc] (p = 0.0002). On NTCP modeling, CV20Gy[cc] ≥ 8.5 cc was associated with a risk of HT < 15%. For smaller thyroids, mean dose and thyroid volume were found to be predictive of HT risk. Model validation demonstrated comparable performances between our model and other published models (AUC 0.69-0.72). CONCLUSION NTCP modeling within our patient cohort suggested that greater than 8.5 cc thyroid volume receiving less than 20 Gy may be a recommended dosimetric guideline to minimize HT risk in breast cancer patients receiving SCV-directed RT.
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Affiliation(s)
- Huakang Huang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - John Roberson
- Department of Radiation Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Wei Hou
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Kartik Mani
- Department of Radiation Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA; Department of Biomedical Informatics, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Edward Valentine
- Department of Radiation Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA; Department of Pharmacology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
| | - Alexander Stessin
- Department of Radiation Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA; Department of Pharmacology, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA.
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Dose-volume derived nomogram as a reliable predictor of radiotherapy-induced hypothyroidism in head and neck cancer patients. Radiol Oncol 2019; 53:488-496. [PMID: 31747379 PMCID: PMC6884936 DOI: 10.2478/raon-2019-0055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to determine the possible predictive value of various dosimetric parameters on the development of hypothyroidism (HT) in patients with head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy. Patients and methods This study included 156 patients with HNSCC who were treated with (chemo)radiotherapy in a primary or postoperative setting between August 2012 and September 2017. Dose-volume parameters as well as V10 toV70, D02 to D98, and the VS10 to VS70 were evaluated. The patients’ hormone status was regularly assessed during follow-up. A nomogram (score) was constructed, and the Kaplan-Maier curves and Log-Rank test were used to demonstrate the difference in incidence of HT between cut-off values of specific variables. Results After a median follow-up of 23.0 (12.0–38.5) months, 70 (44.9%) patients developed HT. In univariate analysis, VS65, Dmin, V50, and total thyroid volume (TTV) had the highest accuracy in predicting HT. In a multivariate model, HT was associated with lower TTV (OR 0.31, 95% CI 0.11–0.87, P = 0.026) and Dmin (OR 9.83, 95% CI 1.89–108.08, P = 0.042). Hypothyroidism risk score (HRS) was constructed as a regression equation and comprised TTV and Dmin. HRS had an AUC of 0.709 (95% CI 0.627–0.791). HT occurred in 13 (20.0%) patients with a score < 7.1 and in 57 (62.6%) patients with a score > 7.1. Conclusions The dose volume parameters VS65, Dmin, V50, and TTV had the highest accuracy in predicting HT. The HRS may be a useful tool in detecting patients with high risk for radiation-induced hypothyroidism.
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Kamal M, Peeler CR, Yepes P, Mohamed AS, Blanchard P, Frank S, Chen L, Jethanandani A, Kuruvilla R, Greiner B, Harp J, Granberry R, Mehta V, Rock C, Hutcheson K, Cardenas C, Gunn G, Fuller C, Mirkovic D. Radiation-Induced Hypothyroidism After Radical Intensity Modulated Radiation Therapy for Oropharyngeal Carcinoma. Adv Radiat Oncol 2019; 5:111-119. [PMID: 32051897 PMCID: PMC7005113 DOI: 10.1016/j.adro.2019.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate 2 published normal tissue complication probability models for radiation-induced hypothyroidism (RHT) on a large cohort of oropharyngeal carcinoma (OPC) patients who were treated with intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS OPC patients treated with retrievable IMRT Digital Imaging and Communications in Medicine (DICOMs) data and available baseline and follow-up thyroid function tests were included. Mean dose (Dmean) to the thyroid gland (TG) and its volume were calculated. The study outcome was clinical HT at least 6 months after radiation therapy, which was defined as grade ≥2 HT per Common Terminology Criteria for Adverse Events grading system (symptomatic hypothyroidism that required thyroid replacement therapy). Regression analyses and Wilcoxon rank-sum test were used. Receiver operating characteristic curves and area under the curve for the fitted model were calculated. RESULTS In the study, 360 OPC patients were included. The median age was 58 years. Most tumors (51%) originated from the base of tongue. IMRT-split field was used in 95%, and median radiation therapy dose was 69.96 Gy. In the study, 233 patients (65%) developed clinical RHT that required thyroid replacement therapy. On multivariate analysis higher Dmean and smaller TG volume maintained the statistically significant association with the risk of clinical RHT (P < .0001). Dmean was significantly higher in patients with clinical RHT versus those without (50 vs 42 Gy, P < .0001). Patients with RHT had smaller TG volume compared with those without (11.8 compared with 12.8 mL, P < .0001). AUC of 0.72 and 0.66 were identified for fitted model versus for the applied Boomsma et al and Cella et al models, respectively. CONCLUSIONS Volume and Dmean of the TG are important predictors of clinical RHT and shall be integrated into normal tissue complication probability models for RHT. Dmean and thyroid volume should be considered during the IMRT plan optimization in OPC patients.
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Affiliation(s)
- Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Christopher Ryan Peeler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pablo Yepes
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Physics and Astronomy, Rice University, Houston, Texas
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt,MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Pierre Blanchard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lei Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rohit Kuruvilla
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Greiner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared Harp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robin Granberry
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Mehta
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Crosby Rock
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G.Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas,MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Dragan Mirkovic
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas,Corresponding author: Dragan Mirkovic, PhD
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Haciislamoglu E, Canyilmaz E, Gedik S, Aynaci O, Serdar L, Yoney A. Effect of dose constraint on the thyroid gland during locoregional intensity-modulated radiotherapy in breast cancer patients. J Appl Clin Med Phys 2019; 20:135-141. [PMID: 31231982 PMCID: PMC6612689 DOI: 10.1002/acm2.12668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to compare radiation dose received by thyroid gland using different radiotherapy (RT) techniques with or without thyroid dose constraint (DC) for breast cancer patients. Computerized tomography (CT) image sets for 10 patients with breast cancer were selected. All patients were treated originally with opposite tangential field-in field (FinF) for the chest wall and anteroposterior fields for the ipsilateral supraclavicular field. The thyroid gland was not contoured on the CT images at the time of the original scheduled treatment. Four new treatment plans were created for each patient, including intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) plans with thyroid DC exclusion and inclusion (IMRTDC(-) , IMRTDC(+) , HTDC(-) , and HTDC(+) , respectively). Thyroid DCs were used to create acceptable dose limits to avoid hypothyroidism as follows: percentage of thyroid volume exceeding 30 Gy less than 50% (V30 < 50%) and mean dose of thyroid (TDmean ) ≤ 21 Gy. Dose-volume histograms (DVHs) for TDmean and percentages of thyroid volume exceeding 10, 20, 30, 40, and 50 Gy (V10 , V20 , V30 , V40 , and V50 , respectively) were also analyzed. The Dmean of the FinF, IMRTDC(-) , HTDC(-) , IMRTDC(+) and HTDC(+) plans were 30.56 ± 5.38 Gy, 25.56 ± 6.66 Gy, 27.48 ± 4.16 Gy, 18.57 ± 2.14 Gy, and 17.34 ± 2.70 Gy, respectively. Median V30 values were 55%, 33%, 36%, 18%, and 17%, for FinF, IMRTDC(-) , HTDC(-) , IMRTDC(+) , and HTDC(+) , respectively. Differences between treatment plans with or without DC with respect to Dmean and V30 values were statistically significant (P < 0.05). When thyroid DC during breast cancer RT was applied to IMRT and HT, the TDmean and V30 values significantly decreased. Therefore, recognition of the thyroid as an organ at risk (OAR) and the use of DCs during IMRT and HT planning to minimize radiation dose and thyroid volume exposure are recommended.
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Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sonay Gedik
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Ozlem Aynaci
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Lasif Serdar
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Dahbi Z, Sbai A, Mezouar L. [Thyroid function after hypofractionated adjuvant radiotherapy for localized breast cancer]. Cancer Radiother 2019; 23:34-37. [PMID: 30595341 DOI: 10.1016/j.canrad.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to evaluate the impact on the thyroid function of hypofractionated adjuvant radiotherapy of localized breast cancer. MATERIAL AND METHOD This was a prospective study, including 50 patients with breast cancer treated by hypofractionated adjuvant radiation, only half of whom received radiotherapy on the supraclavicular region. The analysis focused on clinical, dosimetric and biological data collected through periodic dosing of thyroid hormones. RESULTS The incidence of hypothyroidism was 4% of the patients. The multivariate correlation analysis showed a significant association between initial thyroid volume, volume receiving 50Gy, 40Gy and 30Gy and the incidence of hypothyroidism, no statistical link was found between the bilateral breast, chemotherapy, hormone therapy and the type of surgery and the incidence of radiation-induced hypothyroidism. CONCLUSION Although hypofractionation theoretically exposes the thyroid gland to late radiotherapy complications, radiation-induced dysthyroidism remains a complication underestimated by clinicians, and in the absence of prevention and treatment guidelines, it is necessary to delineate systematically the thyroid gland, to try to minimize as much as possible the doses received by this organ, and to monitor the thyroid function by periodic serum assays.
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Affiliation(s)
- Z Dahbi
- Radiothérapie oncologie, hôpital universitaire Mohammed-VI, BP 2013, Oued Nachef, Oujda, Maroc.
| | - A Sbai
- Radiothérapie oncologie, hôpital universitaire Mohammed-VI, BP 2013, Oued Nachef, Oujda, Maroc
| | - L Mezouar
- Radiothérapie oncologie, hôpital universitaire Mohammed-VI, BP 2013, Oued Nachef, Oujda, Maroc
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24
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A review on the dosimetrical and radiobiological prediction of radiation-induced hypothyroidism in radiation therapy of head-and-neck cancer, breast cancer, and Hodgkin’s lymphoma survivors. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2018. [DOI: 10.2478/pjmpe-2018-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
A review on the radiobiological modeling of radiation-induced hypothyroidism after radiation therapy of head-and-neck cancers, breast cancer, and Hodgkin’s lymphoma is presented. The current review is based on data relating to dose-volume constrains and normal tissue complication probability (NTCP) as a function of either radiobiological or (pre)treatment-clinical parameters. Also, these data were explored in order to provide more helpful criteria for radiobiological optimization of treatment plans involving thyroid gland as a critical normal organ.
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25
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Brodin NP, Tomé WA. Revisiting the dose constraints for head and neck OARs in the current era of IMRT. Oral Oncol 2018; 86:8-18. [PMID: 30409324 DOI: 10.1016/j.oraloncology.2018.08.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 12/25/2022]
Abstract
Head and neck cancer poses a particular challenge in radiation therapy, whilst being an effective treatment modality it requires very high doses of radiation to provide effective therapy. This is further complicated by the fact that the head and neck region contains a large number of radiosensitive tissues, often resulting in patients experiencing debilitating normal tissue complications. In the era of intensity-modulated radiation therapy (IMRT) treatments can be delivered using non-uniform dose distributions selectively aimed at reducing the dose to critical organs-at-risk while still adequately covering the tumor target. Dose-volume constraints for the different risk organs play a vital role in one's ability to devise the best IMRT treatment plan for a head and neck cancer patient. To this end, it is pivotal to have access to the latest and most relevant dose constraints available and as such the goal of this review is to provide a summary of suggested dose-volume constraints for head and neck cancer RT that have been published after the QUANTEC reports were made available in early 2010.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Xu Y, Shao Z, Tang T, Liu G, Yao Y, Wang J, Zhang L. A dosimetric study on radiation-induced hypothyroidism following intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma. Oncol Lett 2018; 16:6126-6132. [PMID: 30405757 DOI: 10.3892/ol.2018.9332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
The objective of the present study was to investigate the association between thyroid gland-dosimetric parameters and hypothyroidism induced by intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma (NPC). A total of 52 patients with NPC treated in the Department of Radiation Oncology of The Affiliated Hospital of Xuzhou Medical University, from May 2008 to December 2016 were retrospectively enrolled in the present study and divided into two groups based on thyroid function: The euthyroid and hypothyroid groups. The association between hypothyroidism and clinical or dosimetric parameters were analyzed. Females had a significantly increased probability of suffering from radiation-induced hypothyroidism (RIHT), compared with males (P=0.010). The occurrence of RIHT was significantly negatively associated with thyroid volume prior to radiotherapy (P=0.048). Furthermore, the mean dose (Dmean) and V50 in the hypothyroidism group were significantly increased, compared with the euthyroidism group (P=0.017 and P=0.023, respectively). During the treatment optimization period, dose constraints associated with the thyroid gland demonstrated a significantly protective effect on thyroid function compared with the unconstrained group (P=0.034). According to the receiver operating characteristic curves, the threshold value was 5,160 cGy for Dmean and 54.5% for V50. The 3-year cumulative incidence of RIHT was 67.8% when the Dmean value was >5,160 cGy and 44.6% when the Dmean was <5,160 cGy (log rank test, P=0.036). Furthermore, the 3-year cumulative incidence was 66.1% when the V50 was >54.5%, and 29.9% when the V50 was <54.5% (log rank test, P=0.025). In conclusion, RIHT is associated with radiation dose, particularly with Dmean and V50 of the thyroid gland. Dose constraints associated with the thyroid gland significantly reduced the incidence of hypothyroidism compared with the unconstrained group.
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Affiliation(s)
- Yumei Xu
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China.,Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Zhiying Shao
- Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Tianyou Tang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Guihong Liu
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Yuanhu Yao
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Jianshe Wang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Longzhen Zhang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
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27
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Luo R, Wu VWC, He B, Gao X, Xu Z, Wang D, Yang Z, Li M, Lin Z. Development of a normal tissue complication probability (NTCP) model for radiation-induced hypothyroidism in nasopharyngeal carcinoma patients. BMC Cancer 2018; 18:575. [PMID: 29776390 PMCID: PMC5960211 DOI: 10.1186/s12885-018-4348-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/08/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The objectives of this study were to build a normal tissue complication probability (NTCP) model of radiation-induced hypothyroidism (RHT) for nasopharyngeal carcinoma (NPC) patients and to compare it with other four published NTCP models to evaluate its efficacy. METHODS Medical notes of 174 NPC patients after radiotherapy were reviewed. Biochemical hypothyroidism was defined as an elevated level of serum thyroid-stimulating hormone (TSH) value with a normal or decreased level of serum free thyroxine (fT4) after radiotherapy. Logistic regression with leave-one-out cross-validation was performed to establish the NTCP model. Model performance was evaluated and compared by the area under the receiver operating characteristic curve (AUC) in our NPC cohort. RESULTS With a median follow-up of 24 months, 39 (22.4%) patients developed biochemical hypothyroidism. Gender, chemotherapy, the percentage thyroid volume receiving more than 50 Gy (V50), and the maximum dose of the pituitary (Pmax) were identified as the most predictive factors for RHT. A NTCP model based on these four parameters were developed. The model comparison was made in our NPC cohort and our NTCP model performed better in RHT prediction than the other four models. CONCLUSIONS This study developed a four-variable NTCP model for biochemical hypothyroidism in NPC patients post-radiotherapy. Our NTCP model for RHT presents a high prediction capability. TRIAL REGISTRATION This is a retrospective study without registration.
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Affiliation(s)
- Ren Luo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Vincent W C Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China
| | - Binghui He
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
| | - Xiaoying Gao
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
| | - Zhenxi Xu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
| | - Dandan Wang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
| | - Zhining Yang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China
| | - Mei Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China.
| | - Zhixiong Lin
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515000, Guangdong, China.
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Lin AJ, Zhang J, Cho-Lim J, Inouye W, Lee SP. Postradiation hypothyroidism in head and neck cancers: A Department of Veterans Affairs single-institution case-control dosimetry study. Med Dosim 2018; 44:56-60. [PMID: 29580932 DOI: 10.1016/j.meddos.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/06/2017] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
We performed a case-control study to characterize the dose-volume relationship and other variables leading to hypothyroidism after head and neck (H&N) cancer radiation therapy (RT) in a homogenous Veterans Affairs (VA) population. All records of patients receiving RT for various H&N cancers at a single VA medical center between 2007 and 2013 (n = 143) were screened for post-RT thyroid stimulating hormone (TSH) levels (n = 77). The thyroid gland was contoured on each slice of the planning computed tomography scan when available (hypothyroid: n = 18; euthyroid > 2 years: n = 16), and dose-volume histograms based on physical dose and biologically equivalent dose (BED) were compared systematically to find the significant dose-volume thresholds that distinguish the patients who developed clinical hypothyroidism. Dosimetric and clinical variables were considered in univariate and multivariate analysis. Preirradiation prevalence of hypothyroidism was 8 of 143 (5.6%). After RT, 36 of 77 (47%) screened patients had abnormally high TSH, of which 22 of 36 (61%) had clinical hypothyroidism after 1.29 ± 0.99 years. The median follow-up durations were 3.3 years and 4.7 years for euthyroid and hypothyroid patients, respectively. Compared with the euthyroid cohort (n = 41), these hypothyroid patients displayed no significant difference in age, gender, primary tumor site, thyroid volume, hypertension, diabetes, or use of chemotherapy, surgery, or intensity-modulated radiation therapy (IMRT). They were more likely to have had stage 3 or 4 cancer than euthyroid patients (86.5% vs 73.2%, p = 0.01). The odds ratios of hypothyroidism for stage 3 + 4 cancers and V50Gy < 75% were 5.0 and 0.2, respectively (p < 0.05). Equivalent BED threshold of V75Gy3 < 75% gave an odds ratio of 0.156 for developing hypothyroidism (p = 0.02). The prevalence of post-RT clinical hypothyroidism was relatively high for patients with H&N cancers and warrants routine surveillance, especially in those with higher stage malignancy. V50Gy < 75% may be a useful guideline to avoid hypothyroidism. We also show BED data which could be used for unconventionally fractionated schemes, and V75Gy3 < 75% may be a useful guideline.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, VA Long Beach Healthcare System, Long Beach, CA; Department of Radiation Oncology, University of California, Irvine, CA
| | - Juying Zhang
- Department of Radiation Oncology, VA Long Beach Healthcare System, Long Beach, CA; Department of Radiation Oncology, University of California, Irvine, CA
| | - Jennie Cho-Lim
- Department of Radiation Oncology, VA Long Beach Healthcare System, Long Beach, CA; Department of Radiation Oncology, University of California, Irvine, CA
| | - Warren Inouye
- Department of Radiation Oncology, VA Long Beach Healthcare System, Long Beach, CA; Department of Radiation Oncology, University of California, Irvine, CA
| | - Steve P Lee
- Department of Radiation Oncology, VA Long Beach Healthcare System, Long Beach, CA; Department of Radiation Oncology, University of California, Los Angeles, CA.
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El-Shebiney M, El-Mashad N, El-Mashad W, El-Ebiary AA, Kotkat AE. Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer. J Egypt Natl Canc Inst 2018; 30:33-38. [PMID: 29428369 DOI: 10.1016/j.jnci.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study is to determine radiotherapy (RT) dose-volumetric threshold of radiation-induced hypothyroidism (HT) in head and neck squamous cell carcinoma (HNSCC) patients. PATIENTS AND METHODS The diagnosis of HT in 78 HNSCC patients treated with RT was based on a thyroid stimulating hormone (TSH) level greater than the maximum value of laboratory range. In all patients, dose-volumetric parameters were analyzed according to their relation to development of HT, and thyroid volumes spared from doses ≥10, 20, 30, 40 and 50 Gy (V10, V20, V30, V40 and V50) were analyzed from the dose volume histograms (DVHs). RESULTS Median follow-up duration was 31 months. At the end of study, 33 patients (42.3%) developed HT and the cumulative incidence of HT was 24.6%, 36.5% and 42.3% at one, two and three years, respectively. V30 of 42.1% (P = 0.005) was defined as dose-volumetric threshold of radiation-induced HT in HNSCC patients. Our analysis showed that V30 separates patients into low- and high-risk groups; the incidence of radiation-induced HT in the group with V30 < 42.1% and V30 ≥ 42.1% was 29.4% and 71.4%, respectively (P = 0.002). CONCLUSIONS The V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.
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Affiliation(s)
- Mohamed El-Shebiney
- Clinical Oncology Department, Faculty of Medicine, Tanta University Hospital, Egypt
| | - Nehal El-Mashad
- Clinical Oncology Department, Faculty of Medicine, Tanta University Hospital, Egypt.
| | - Wael El-Mashad
- Physiology Department, Faculty of Medicine, Tanta University Hospital, Egypt
| | - Ahmed A El-Ebiary
- Forensic Medicine and Clinical Toxicology Departement, Faculty of Medicine, Tanta University Hospital, Egypt
| | - Abdallah E Kotkat
- Medical Physics Specialist & RSO, Faculty of Medicine, Tanta University Hospital, Egypt
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Brodin NP, Kabarriti R, Garg MK, Guha C, Tomé WA. Systematic Review of Normal Tissue Complication Models Relevant to Standard Fractionation Radiation Therapy of the Head and Neck Region Published After the QUANTEC Reports. Int J Radiat Oncol Biol Phys 2017; 100:391-407. [PMID: 29353656 DOI: 10.1016/j.ijrobp.2017.09.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
There has recently been an increasing interest in model-based evaluation and comparison of different treatment options in radiation oncology studies. This is partly driven by the considerable technical advancements in radiation therapy of the last decade, leaving radiation oncologists with a multitude of options to consider. In lieu of randomized trials comparing all of these different treatment options for varying indications, which is unfeasible, treatment evaluations based on normal tissue complication probability (NTCP) models offer a practical alternative. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) effort, culminating in a number of reports published in 2010, provided a basis for many of the since-implemented dose-response models and dose-volume constraints and was a key component for model-based treatment evaluations. Given that 7 years have passed since the QUANTEC publications and that patient-reported outcomes have emerged as an important consideration in recent years, an updated summary of the published radiation dose-response literature, which includes a focus on patient-reported quality of life outcomes, is warranted. Here we provide a systematic review of quantitative dose-response models published after January 1, 2010 for endpoints relevant to radiation therapy for head and neck cancer, because these patients are typically at risk for a variety of treatment-induced normal tissue complications.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Rafi Kabarriti
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Madhur K Garg
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Chandan Guha
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
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Kikawa Y, Kosaka Y, Hashimoto K, Hohokabe E, Takebe S, Narukami R, Hattori T, Ueki K, Ogura K, Imagumbai T, Kato H, Kokubo M. Prevalence of hypothyroidism among patients with breast cancer treated with radiation to the supraclavicular field: a single-centre survey. ESMO Open 2017; 2:e000161. [PMID: 28761733 PMCID: PMC5519789 DOI: 10.1136/esmoopen-2017-000161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose We investigated the prevalence of hypothyroidism (HT) in patients with breast cancer who received radiation therapy to the supraclavicular (SC) field to evaluate the effect of radiation on thyroid. Methods Between April 2007 and May 2016, consecutive patients with invasive breast cancer who received SC radiation were recruited. Thyroid-stimulating hormone (TSH) and free thyroxine (fT4) were measured between April and August 2016. On the basis of the radiation-planning CT images, thyroid volume was calculated and dose–volume parameters were estimated. The endpoints were the prevalence of HT as determined by high levels of TSH and low levels of fT4 in serum, and the prevalence of subclinical HT, determined by high-serum TSH and normal fT4. Results Among the 68 consecutive patients, 26 were excluded from evaluation (10 patients died, 6 had a history of previous thyroid disease and 10 were lost to follow-up). One (2.4%) and six (14.3%) of these patients had HT and subclinical HT, respectively, with a mean TSH level of 8.27 µU/mL. By univariate analysis, a predictive factor of HT and subclinical HT was a thyroid volume <8 cm3 (OR 6.44, 95% CI 1.14 to 36.6; p=0.043). Multivariate analysis also showed an association between thyroid volume <8 cm3 and HT or subclinical HT (OR 18.48, 95% CI 1.48 to 230.86; p=0.024). Conclusions The prevalence of HT in patients with breast cancer studied was relatively low. Although thyroid volume appeared to be a predictive marker of HT in this cohort, further prospective evaluation is needed.
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Affiliation(s)
- Yuichiro Kikawa
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Kosaka
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuki Hashimoto
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eri Hohokabe
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Sayaka Takebe
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryo Narukami
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Hattori
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Ueki
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kengo Ogura
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshiyuki Imagumbai
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hironori Kato
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
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Thyroid V50 Highly Predictive of Hypothyroidism in Head-and-Neck Cancer Patients Treated With Intensity-modulated Radiotherapy (IMRT). Am J Clin Oncol 2017; 40:413-417. [DOI: 10.1097/coc.0000000000000165] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Thyroid V40 Predicts Primary Hypothyroidism After Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2017; 98:574-580. [DOI: 10.1016/j.ijrobp.2017.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 03/04/2017] [Accepted: 03/04/2017] [Indexed: 12/25/2022]
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Zhai RP, Kong FF, Du CR, Hu CS, Ying HM. Radiation-induced hypothyroidism after IMRT for nasopharyngeal carcinoma: Clinical and dosimetric predictors in a prospective cohort study. Oral Oncol 2017; 68:44-49. [DOI: 10.1016/j.oraloncology.2017.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/28/2017] [Accepted: 03/12/2017] [Indexed: 12/19/2022]
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Luo R, Li M, Yang Z, Zhan Y, Huang B, Lu J, Xu Z, Lin Z. Nomogram for radiation-induced hypothyroidism prediction in nasopharyngeal carcinoma after treatment. Br J Radiol 2017; 90:20160686. [PMID: 27885853 PMCID: PMC5685104 DOI: 10.1259/bjr.20160686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/09/2016] [Accepted: 11/22/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to develop a nomogram for radiation-induced hypothyroidism (RHT) prediction. METHODS We collected data from 164 patients with nasopharyngeal carcinoma (NPC) in our previous prospective study. Biochemical hypothyroidism was defined as a serum thyroid-stimulating hormone level greater than the normal value. We collected both clinical and dose-volume factors. A univariate Cox regression analysis was performed to identify RHT risk factors. Optimal predictors were selected according to the least absolute shrinkage and selection operator (LASSO). We then selected the Cox regression models that best balanced the prediction performance and practicability to build a nomogram for RHT prediction. RESULTS There were 38 (23.2%) patients who developed RHT, and the median follow-up was 24 months. The univariate Cox regression analysis indicated that gender, minimum dose, mean dose (Dmean) and V25-V60 [Vx (%), the percentage of thyroid volume receiving >x Gy] of the thyroid were significantly associated with RHT. The variables of gender, receiving chemotherapy or not (chemo), Dmean and V50 were selected using the LASSO analysis. A nomogram based on a three-variable (gender, chemo and V50) Cox regression model was constructed, and its concordance index was 0.72. Good accordance between prediction and observation was showed by calibration curves in the probability of RHT at 18, 24 and 30 months. CONCLUSION This study built a nomogram for RHT in NPC survivors by analyzing both clinical and dose-volume parameters using LASSO. Thus, the individual dose constraint could be achieved in a visual format. Advances in knowledge: This study used LASSO to more accurately address the multicollinear problem between variables. The resulting nomogram will help physicians predict RHT.
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Kanyilmaz G, Aktan M, Koc M, Demir H, Demir LS. Radiation-induced hypothyroidism in patients with breast cancer: a retrospective analysis of 243 cases. Med Dosim 2017; 42:190-196. [DOI: 10.1016/j.meddos.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 12/19/2022]
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Dosimetric Predictors of Hypothyroidism After Radical Intensity-modulated Radiation Therapy for Non-metastatic Nasopharyngeal Carcinoma. Clin Oncol (R Coll Radiol) 2016; 28:e52-60. [PMID: 27235379 DOI: 10.1016/j.clon.2016.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/25/2016] [Accepted: 04/06/2016] [Indexed: 11/23/2022]
Abstract
AIMS To investigate dosimetric predictors of hypothyroidism after radical intensity-modulated radiation therapy (IMRT) for non-metastatic nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS Patients with non-metastatic NPC treated with radical IMRT from 2008 to 2013 were reviewed. Serum thyroid function tests before and after IMRT were regularly monitored. Univariable and multivariable analyses were carried out for predictors of biochemical and clinical hypothyroidism. RESULTS In total, 149 patients were recruited. After a median follow-up duration of 3.1 years, 33 (22.1%) and 21 (14.1%) patients developed biochemical and clinical hypothyroidism, respectively. Eight (24.2%) patients who had biochemical hypothyroidism developed clinical hypothyroidism later. Univariable and multivariable analyses revealed that the volume of the thyroid (P=0.002, multivariable), VS60 (the absolute thyroid volume spared from 60 Gy or less) (P<0.001, multivariable) and VS45 (P<0.001, multivariable) of the thyroid were significant predictors of biochemical hypothyroidism. The freedom from biochemical hypothyroidism was longer for those whose VS60 ≥ 10 cm(3) (mean 90.9 versus 62.6 months; P<0.001) and VS45 ≥ 5 cm(3) (mean 91.9 versus 65.2 months; P=0.001). Similarly multivariable analyses revealed that VS60 (P=0.001) and VS45 (P=0.003) were significant predictors of clinical hypothyroidism. The freedom from clinical hypothyroidism was longer for those whose VS60 ≥ 10 cm(3) (91.5 versus 73.3 months; P=0.002) and VS45 ≥ 5 cm(3) (91.5 versus 75.9 months; P=0.007). CONCLUSIONS VS60 and VS45 of the thyroid should be considered important dose constraints against hypothyroidism without compromising target coverage during IMRT optimisation for NPC.
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Lu JY, Wu LL, Zhang JY, Zheng J, Cheung MLM, Ma CC, Xie LX, Huang BT. Improving target dose coverage and organ-at-risk sparing in intensity-modulated radiotherapy of advanced laryngeal cancer by a simple optimization technique. Br J Radiol 2015; 88:20140654. [PMID: 25494885 PMCID: PMC4614243 DOI: 10.1259/bjr.20140654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/02/2014] [Accepted: 12/11/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate a simple optimization technique intended to improve planning target volume (PTV) dose coverage and organ-at-risk (OAR) sparing in intensity-modulated radiotherapy (IMRT) of advanced laryngeal cancer. METHODS Generally acceptable initial IMRT plans were generated for 12 patients and were improved individually by the following two techniques: (1) base dose function-based (BDF) technique, in which the treatment plans were reoptimized based on the initial IMRT plans; (2) dose-controlling structure-based (DCS) technique, in which the initial IMRT plans were reoptimized by adding constraints for hot and cold spots. The initial, BDF and DCS IMRT plans and additionally generated volumetric modulated arc therapy (VMAT) plans were compared concerning homogeneity index (HI) and conformity index (CI) of PTVs prescribed at 70 Gy/60 Gy (PTV70/PTV60), OAR sparing, monitor units (MUs) per fraction and total planning time. RESULTS Compared with the initial IMRT and DCS IMRT plans, the BDF technique provided superior HI/CI, by approximately 19-37%/4-11%, and lower doses to most OARs, by approximately 1-7%, except for the comparable HI of PTV60 to DCS IMRT plans. Compared with VMAT plans, the BDF technique provided comparable HI, CI and most-OAR sparing, except for the superior HI of PTV70, by approximately 13%. The BDF technique produced more MUs and reduced the planning time. CONCLUSION The BDF optimization technique for IMRT of advanced laryngeal cancer can improve target dose homogeneity and conformity, spare most OARs and is efficient. ADVANCES IN KNOWLEDGE A novel optimization technique for improving IMRT was assessed and found to be effective and efficient.
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Affiliation(s)
- J-Y Lu
- 1 Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
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