Hypothyroidism after primary radiotherapy for head and neck squamous cell carcinoma: Normal tissue complication probability modeling with latent time correction

Rønjom, Marianne Feen; Brink, Carsten; Bentzen, Søren M.; Hegedűs, László; Overgaard, Jens; Johansen, Jørgen

doi:10.1016/j.radonc.2013.06.029

Cited by 57 publications

(101 citation statements)

References 31 publications

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“…carcinomas of larynx, oropharynx and hypopharynx) could be significant, because it is located in very close proximity to the target of irradiation. [3,13,26,27] Conversely, some studies found no association between HT and primary tumor site irradiation, [6,7,21] as in our study.…”

Section: Discussioncontrasting

confidence: 59%

“…[3,5,6] In our study, The MRT independent of thyroid volume was 52.2 Gy. Differently, some studies reported that radiation dose-volumetric parameters could be a beneficial for post-RT HT.…”

Section: Discussionsupporting

confidence: 46%

“…[12] In the present study, the incidence of HT was found as 34.4%, which is within the range of values (17-51%) reported in the literature. [3][4][5][6] This instability of the incidence ratios could be related to multiple variables such as age, sex, irradiation dose, surgery, concurrent chemoradiotherapy, and follow-up periods. Furthermore, subclinical HT (74%) constituted a higher portion of post-RT HT, and that was in agreement with some studies, [6,13] but contra to others [2,14] that found a higher proportion of clinical HT.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, Rønjom et al [6] excluded patients with nasopharynx carcinoma in a study of post-RT HT, because they were concerned about the likely radiation effect on the pituitary gland and consequent occurrence of central HT. However, in our analysis results, we found no clues related with central HT.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Hypothyroidism after RT alone or in combination with surgery and/or chemotherapy for HNCs has been well reported between 17% and 51% in the literature. [3][4][5][6] However, thyroid dysfunction after RT for HNC still represents a clinically underestimated problem. [7] Our study is based on the question of "When should we be concerned for post-RT HT?"…”

mentioning

confidence: 99%

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Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?

Çelık¹

2017

Kulak Burun Bogaz Ihtis Derg

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Objectives:This study aims to analyze the incidence of hypothyroidism (HT) in patients who underwent radiotherapy (RT) for head and neck cancers (HNC), and to determine risk factors. Patients and Methods:This study was a retrospective analysis of patients who were treated with RT alone or in combination with surgery and/or chemotherapy between January 2005 and May 2012. Patients were grouped according to the primary tumor site, TNM staging system, age, gender, total radiation dose (TRD), mean radiation dose of thyroid gland (MRT), neck dissection, and chemotherapy.Results: A total of 90 patients who were treated with RT were analyzed. The median age was 52±13 (range, 12-87) years. The histopathologic finding of 88 patients was squamous cell carcinoma, others were adenocystic carcinoma and undifferentiated carcinoma. The median follow-up of all patients after RT was 15 (range, 6-72) months. Post-radiotherapy HT was found in 31 patients (34.4%). In this group, clinical and subclinical HT was present in eight (26%) and 23 (74%) patients, respectively. Age younger than 60 years and increased MRT (especially mean thyroid dose 20 Gy<) were significant risk factors for post-radiotherapy HT (p<0.05). Conclusion:Physicians should pay more attention to HT in patients who were treated with RT for HNC during follow-up.Keywords: Head and neck cancers; hypothyroidism; mean radiation dose of thyroid gland; radiotherapy; thyroid gland. Sonuç: Hekimler, takip sırasında HNC için RT ile tedavi edilen hastalarda HT'ye daha fazla dikkat etmelidirler.Anahtar Sözcükler: Baş ve boyun kanserleri; hipotiroidizm; tiroid bezinin ortalama radyasyon dozu; radyoterapi; tiroid bezi.

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Section: Discussioncontrasting

confidence: 59%

“…[3,5,6] In our study, The MRT independent of thyroid volume was 52.2 Gy. Differently, some studies reported that radiation dose-volumetric parameters could be a beneficial for post-RT HT.…”

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?

Çelık¹

2017

Kulak Burun Bogaz Ihtis Derg

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Individualized elective irradiation of the clinically node‐negative neck in definitive radiotherapy for head and neck squamous cell carcinoma

Kou

Jiao

et al. 2021

Cancer Communications

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Background Oral cavity (OC), oropharyngeal (OP), hypopharyngeal (HP), and laryngeal (LA) squamous cell carcinoma (SCC) have a high incidence of regional lymph node metastasis (LNM). Elective irradiation for clinically node‐negative neck is routinely administered to treat lymph nodes harboring occult metastasis. However, the optimal elective irradiation schemes are still inconclusive. In this study, we aimed to establish individualized elective irradiation schemes for the ipsilateral and contralateral node‐negative neck of these four types of cancer. Methods From July 2005 to December 2018, 793 patients with OC‐SCC, 464 with OP‐SCC, 413 with HP‐SCC, and 645 with LA‐SCC were recruited retrospectively. Based on the actual incidence of LNM and the tumor characteristics, risk factors for contralateral LNM, as well as node level coverage schemes for elective irradiation, were determined using logistic regression analysis. Additionally, we developed a publicly available online tool to facilitate the widespread clinical use of these schemes. Results For the ipsilateral node‐negative neck, elective irradiation at levels I‐III for OC‐SCC and levels II‐IVa for OP‐, HP‐ and LA‐SCC are generally recommended. In addition, level VIIa should be included in patients with OP‐SCC. Multivariate analyses revealed that posterior hypopharyngeal wall and post‐cricoid region involvement were independently associated with level VIIa metastasis in HP‐SCC (all P < 0.05). For the contralateral node‐negative neck, multivariate analyses revealed that ipsilateral N2b2‐N3, tumors with body midline involvement, and degree of tumor invasion were the independent factors for contralateral LNM (all P < 0.05). In patients who require contralateral neck irradiation, levels I‐II are recommended for OC‐SCC, and additional level III is recommended for patients with ipsilateral N3 disease. Levels II‐III are recommended for OP‐, HP‐, and LA‐SCC, and additional level IVa is recommended for patients with advanced T or ipsilateral N classifications. Furthermore, additional level VIIa is recommended only for OP‐SCC with T4 and ipsilateral N3 disease. Conclusion Based on our findings, we suggest that individualized and computer‐aided elective irradiation schemes could reduce irradiation volumes in OC‐, OP‐ and HP‐SCC patients, as compared to current guidelines, and could thus positively impact the patients' quality of life after radiotherapy.

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Thyroid dose‐volume thresholds for the risk of radiation‐related hypothyroidism in nasopharyngeal carcinoma treated with intensity‐modulated radiotherapy—A single‐institution study

Huang

Tan²,

Guo

et al. 2019

Cancer Medicine

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BackgroundTo identify thyroid dose‐volume thresholds for radiotherapy (RT)‐related hypothyroidism (HT) in patients with nasopharyngeal carcinoma (NPC) treated with intensity‐modulated RT (IMRT). In this way, we desired to guide the design of treatment plans and, finally, lower HT prevalence.MethodsIn total, 345 NPC patients treated with IMRT were evaluated retrospectively during a median follow‐up of 45.2 (range, 11.3‐64.9) months. Serum‐based assessments of thyroid function before and after IMRT were monitored periodically. Thyroid dose‐volume parameters were analyzed for their association with HT risk.ResultsIn total, 44.1% of patients (152/345) developed primary HT. Analyses of thyroid dose‐volume parameters identified a stringent dose‐volume histogram (DVH) threshold defined by V 25Gy (the percentage thyroid volume that receives >25 Gy, not the absolute volume) ≤60%, V 35Gy ≤ 55%, and V 45Gy ≤ 45%. Patients whose thyroid DVHs satisfied these constraints had a lower prevalence of 2‐year HT compared with the overall prevalence (13.2% vs 25.8%, P < .001). Another DVH was defined by V 25Gy > 95%, V 35Gy > 90%, and V 45Gy > 75%, and patients whose thyroid DVHs satisfied with these constraints had a higher prevalence of 2‐year HT than the overall incidence (36.0% vs 25.8%, P < .001).ConclusionWe recommend V 25Gy ≤ 60%, V 35Gy ≤ 55%, and V 45Gy ≤ 45% as the “stringent” DVH line, and V 25Gy > 95%, V 35Gy > 90%, and V 45Gy > 75% as the “inhibition” DVH line, under the precondition of not compromising the target coverage. These findings could help in the design of individual treatment plans and, eventually, to lowering of HT prevalence.

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Hypothyroidism after primary radiotherapy for head and neck squamous cell carcinoma: Normal tissue complication probability modeling with latent time correction

Cited by 57 publications

References 31 publications

Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?

Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?

Individualized elective irradiation of the clinically node‐negative neck in definitive radiotherapy for head and neck squamous cell carcinoma

Thyroid dose‐volume thresholds for the risk of radiation‐related hypothyroidism in nasopharyngeal carcinoma treated with intensity‐modulated radiotherapy—A single‐institution study

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