Thyroid V30 Predicts Radiation-Induced Hypothyroidism in Patients Treated With Sequential Chemo-Radiotherapy for Hodgkin’s Lymphoma

Cella, Laura; Conson, Manuel; Caterino, Michele; Rosa, Nicola; Liuzzi, Raffaele; Picardi, Marco; Grimaldi, Francesco; Solla, Raffaele; Farella, A.; Salvatore, Marco; Pacelli, Roberto

doi:10.1016/j.ijrobp.2010.09.054

Cited by 74 publications

(81 citation statements)

References 35 publications

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“…Doses to the thyroid may be reduced without compromising target coverage. The study by Cella et al 17 showed that 42% of the 53 patients with Hodgkin's lymphoma treated by 3D-CRT experienced biochemical HT. The authors suggested V 30 of 62.5% as the threshold value for the thyroid gland.…”

Section: Discussionmentioning

confidence: 99%

“…10,15 Threedimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) enable the analysis of dose-volume factors. The minimum dose (D min ) and mean dose (D mean ), the percentage of thyroid volume receiving .30, 45 or 50 Gy, the absolute thyroid volume spared from 45 Gy or less and volume spared from 60 Gy or less 13,14,[16][17][18][19][20][21][22][23][24] were found to be dosimetric predictors for RHT. However, predictors and dose constraints varied according to the study.…”

Section: Introductionmentioning

confidence: 98%

“…However, predictors and dose constraints varied according to the study. 13,14,[16][17][18][19][20][21][22][23][24][25] Nasopharyngeal carcinoma (NPC) is a prevalent cancer in southern China. Irradiation to the bilateral neck is a regular practice because of a high incidence 26 of neck node involvement.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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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 risk of developing hypothyroidism was 11.5% if the percentage of the thyroid gland receiving 30 Gy (V30) was 62.5% or lower, whereas the risk was 70.8% if the thyroid gland V30 was .62.5% (P 5 .0001). 34 Several types of HL therapy can result in sterility, including pelvic radiotherapy and exposure to alkylating chemotherapy regimens such as MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), the historical regimen for HL. Both escalated and baseline BEACOPP, regimens developed by the GHSG for patients with advanced HL, are associated with a risk of azoospermia in over 90% of male HL patients.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…6,8 Additional research efforts on correlating radiation dosimetric parameters of specific organs with late effects would improve our understanding of the relationship between radiation dosevolume and long-term risks and guide future radiation treatment planning. 24,34 There are emerging data on an association between anthracyclines and, not just cardiac risk, but also solid tumors, and further follow-up is needed to confirm the findings. 52 Finally, as new targeted agents are adopted for HL, their long-term risks need to be fully assessed.…”

Section: Future Directionsmentioning

confidence: 99%

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Blood

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Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected earlydetection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of longterm HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. (Blood. 2014; 124(23):3373-3379)

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Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

et al. 2020

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IMPORTANCE Response-adapted randomized trials have used positron emission tomographycomputed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects. OBJECTIVE To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD. DESIGN, SETTING, AND PARTICIPANTS This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center. EXPOSURES 2 cycles of chemotherapy followed by 20-Gy involved-site RT. MAIN OUTCOMES AND MEASURES The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method. RESULTS The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy). CONCLUSIONS AND RELEVANCE In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.

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Thyroid V30 Predicts Radiation-Induced Hypothyroidism in Patients Treated With Sequential Chemo-Radiotherapy for Hodgkin’s Lymphoma

Cited by 74 publications

References 35 publications

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

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

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

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