Normal Tissue Complication Probability Modeling of Radiation-Induced Hypothyroidism After Head-and-Neck Radiation Therapy

Bakhshandeh, Mohsen; Hashemi, Bijan; Mahdavi, Seied Rabi; Nikoofar, Alireza; Vasheghani, Maryam; Kazemnejad, Anoshirvan

doi:10.1016/j.ijrobp.2012.03.034

Cited by 64 publications

(65 citation statements)

References 19 publications

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“…13,14,18,28 However, NTCP model is not convenient in clinical practice. A nomogram is widely used for cancer prognosis and reduces statistical predictive models into a graphical format.…”

Section: Introductionmentioning

confidence: 99%

Nomogram for radiation-induced hypothyroidism prediction in nasopharyngeal carcinoma after treatment

Luo

et al. 2017

The British Journal of Radiology

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The authors Ren Luo and Mei Li contributed equally to this work.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 (D mean ) and V 25 -V 60 [V x (%), 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), D mean and V 50 were selected using the LASSO analysis. A nomogram based on a three-variable (gender, chemo and V 50 ) 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. INTRODUCTIONRadiation-induced hypothyroidism (RHT) is a common late complication after irradiation to the neck area. The majority of early RHT cases are silent because subclinical hypothyroidism (HT) can be detected only by thyroid hormone tests [elevated serum thyroid-stimulating hormone (TSH) and normal serum free thyroxine (fT4) and/ or serum free triiodothyronine (fT3)]. However, other cases show overt disease [overt hypothyroidism (overt HT)] that presents with elevated TSH and decreased fT4 and/or fT3. The incidence of subclinical HT is 24-50%, and overt HT develops in 6-20% of patients with head and neck cancer who receive radiotherapy (RT).1 HT has been demonstrated to be correlated with the development of cardiovascular and pulmonary disorders in addition to diabetes mellitus, 2-7 which increases the adverse effects of RHT on patient quality of life.

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“…13,14,18,28 However, NTCP model is not convenient in clinical practice. A nomogram is widely used for cancer prognosis and reduces statistical predictive models into a graphical format.…”

Section: Introductionmentioning

confidence: 99%

Nomogram for radiation-induced hypothyroidism prediction in nasopharyngeal carcinoma after treatment

Luo

et al. 2017

The British Journal of Radiology

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“…Hearing preservation has been reported to be significantly related to the radiation dose to the cochlea 2,3 and is found between 0.5 and 2.0 years after irradiation. 3 Similarly, the pituitary gland or the hypothalamus is also generally close to the target volume, and partial pituitary failures are commonly reported during radiation-induced late effects [4][5][6] with speeds of onset ranging from a few months to several years. As a wide range of doses are delivered to these critical structures, the objective of this study was to determine the dose-response relationship of the inner ear and the pituitary gland for radiation-induced late effects of photon and proton therapy and to show that generalized equivalent uniform dose (gEUD) may be used as a predictive factor for late complications.…”

mentioning

confidence: 99%

Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy

Marzi¹,

Feuvret²,

Boulé³

et al. 2015

BJR

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Objective: To determine the relationship between the dose to the inner ear or pituitary gland and radiationinduced late effects of skull base radiation therapy. Methods: 140 patients treated between 2000 and 2008 were considered for this study. Hearing loss and endocrine dysfunction were retrospectively reviewed on pre-and post-radiation therapy audiometry or endocrine assessments. Two normal tissue complication probability (NTCP) models were considered (LymanKutcher-Burman and log-logistic) whose parameters were fitted to patient data using receiver operating characteristics and maximum likelihood analysis. The method provided an estimation of the parameters of a generalized equivalent uniform dose (gEUD)-based NTCP after conversion of dose-volume histograms to equivalent doses.

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“…5,8,12 Estima-se que o risco de progressão de hipotiroidismo subclínico para clínico seja de 2-5% por ano.…”

Section: 12unclassified

“…[1][2][3][4] A irradiação direta da glândula tiroideia pode resultar, com maior frequência, em hipotiroidismo. 1,5 Outras complicações podem incluir: tiroidite, Doença de Graves, adenomas, bócio multinodular ou mesmo carcinoma. 1,4,[5][6][7][8][9][10] O hipotiroidismo é uma situação geralmente irreversí-vel, requerendo monitorização e tratamento permanente.…”

Section: Introductionunclassified

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Hipotiroidismo Secundário à Irradiação Cervical: Avaliação Sistemática da Função Tiroideia no Seguimento

et al. 2014

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Em 51,9% dos doentes foi efetuado o diagnóstico de hipotiroidismo entre os 9 e os 12 meses após o tratamento de radioterapia. Discussão: Da análise da literatura publicada, o hipotiroidismo constitui a complicação tiroideia radioinduzida mais frequente e afeta uma grande percentagem de doentes submetidos a radioterapia cervical com intenção curativa. Foi demonstrado que o risco de hipotiroidismo aumenta com o tempo após a exposição, contudo a incidência mais elevada parece ser nos dois primeiros anos após o tratamento. Da nossa análise obtivemos, aos 12 meses uma taxa de incidência global de hipotiroidismo de 18,6%, (grau 1 de 16,55% e grau 2 de 2,1%). Conclusão: Neste estudo foi encontrada uma incidência de hipotiroidismo correspondente aos valores mais baixos descritos em outros estudos publicados. O curto tempo de follow-up considerado nesta análise poderá justificar os resultados obtidos. Face aos resultados obtidos, e correlacionando-os com a literatura disponível, os autores consideram justificável e recomendável a inserção da avaliação sistemática da função tiroideia no protocolo de follow-up destes doentes. Palavras-chave: Neoplasias da Cabeça e Pescoço; Radioterapia; Hipotiroidismo; Estudos de Seguimento.

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Normal Tissue Complication Probability Modeling of Radiation-Induced Hypothyroidism After Head-and-Neck Radiation Therapy

Cited by 64 publications

References 19 publications

Nomogram for radiation-induced hypothyroidism prediction in nasopharyngeal carcinoma after treatment

Nomogram for radiation-induced hypothyroidism prediction in nasopharyngeal carcinoma after treatment

Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy

Hipotiroidismo Secundário à Irradiação Cervical: Avaliação Sistemática da Função Tiroideia no Seguimento

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