with RITD and HT (P < 0.05). V25 was the most predictive of RITD (P Z 0.0008) and HT (P Z 0.0002). An optimal single cutoff point of 63.9% for V25 divided patients into high (80%, n Z 48) and low (37%, n Z 11) risk groups for the development of RITD (P < 0.001). Use of a TAS was associated with lower rates of RITD and HT (P < 0.05). Of the 78 patients that were not planned with a TAS, 71% (n Z 55) developed RITD compared to 33% (n Z 4) of 12 patients that had IMRT planned with a TAS (P Z 0.02). The optimal cutoff for V20 and V30 were 87.0% and 65.1% respectively, with identical sensitivity and comparable specificity compared to the cutpoints identified in the external dataset. Conclusion: The volume of thyroid gland that received 25 Gy predicts the risk of developing RITD and HT after RT with IMRT for HL. Significant V20 and V30 cutoff points identified in patients treated with IMRT are similar to cutoffs identified in an external 3D dataset. Radiation oncologists can decrease the risk of this toxicity through the utilization of a TAS in IMRT planning.
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