Thyroid V50 is a risk factor for hypothyroidism in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a retrospective study

Zhou, Ling; Chen, Jia; Shen, Wei; Chen, Zheng Lu; Huang, Shuang; Chang, Tao; Chen, Ming; Yu, Zepeng; Chen, Yuan Yuan

doi:10.1186/s13014-020-01490-x

Cited by 16 publications

(23 citation statements)

References 30 publications

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“…Specifically, the N-stage represents lymph nodes stage, which refers to the size and extent of cervical lymph node metastasis. In our previous study, Nstage was an independent predictor of the incidence of HT [7], which is consistent with other studies [8,9]. Nonetheless, the relationship between N-stage and incidence of HT is still controversial, and as yet, there is no independent study to explore its internal relationship.…”

Section: Introductionsupporting

confidence: 89%

“…In contrast with the aforementioned conclusion, Koc and Capoglu [16] suggested that the clinical stage of NPC has no effect on the incidence of HT. In our previous study, N-stage played a major role in the NTCP model for predicting HT in NPC patients, and the incidence of HT in N 2-3 patients and N 0-1 patients was 58.82% and 44.29%, respectively [7]. e results of this study showed that N-stage can predict the incidence of HT again, and patients with advanced N-stage will inevitably receive higher irradiated volume of the tumor, resulting in a higher risk of thyroid irradiation.…”

Section: Discussionmentioning

confidence: 96%

“…At present, there are few studies on the risk factors related to radiation-induced HT, and its incidence is mainly related to radiation dose, chemotherapy, clinical stage, and other factors [4,14]. Our previous study found that N-stage, radiation dose, and volume of thyroid are independent predictors of HT, combined with N-stage, dosimetric parameters, and volume to build an NTCP model [7], but the performance was not very good, which was also the limitation of most similar studies. To our best knowledge, this is the first retrospective study to analyze the number, size, and the shortest distance between the metastatic lymph nodes and thyroid and the correlation between these and the incidence of HT.…”

Section: Discussionmentioning

confidence: 99%

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Association between Cervical Lymph Node Metastasis and the Incidence of Radiation-Induced Hypothyroidism in Nasopharyngeal Carcinoma

Zhou

Chen

Tao

et al. 2022

Journal of Oncology

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Background. It is controversial and unclear how N-stage would increase the risk of incidence of hypothyroidism (HT) for patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Our study aimed to explore the correlation between cervical lymph node metastasis and the incidence of HT in NPC. Materials and Methods. A total of 206 patients with NPC treated at the Cancer Hospital of University of Chinese Academy of Sciences, and their clinical information were retrospectively collected. A series of univariate logistic regression models were performed to explore the association of clinical and lymph node indices with the development of HT. Significant features in univariate analysis were then used to construct three prediction models, for HT prediction using multivariate logistic regression based on Bayesian information criterion. Prediction performance of those models was measured by area under the receiver operating characteristic curve (AUC) using 10-fold cross-validation. Results. A total of 111 patients developed HT, and the incidence of HT in N2–3 and N0–1 patients was 58.82% and 44.29%, respectively. Compared to Model 1 (consisted of pretreatment TSH concentration, thyroid volume, and N-stage) whose AUCs were 0.801 and 0.766 in training and validation sets, with N-stage be replaced by shortest distance from thyroid, Model 2 achieved more stable AUCs of 0.824 and 0.801. While with numbers of positive lymph nodes in Level IIb additionally added, Model 3 improved its AUCs to 0.841 and 0.813. Conclusion. The shortest distance between the lymph nodes and thyroid gland and the number of lymph nodes in IIb are better predictors of radiation-induced HT than the N-stage.

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Section: Introductionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Association between Cervical Lymph Node Metastasis and the Incidence of Radiation-Induced Hypothyroidism in Nasopharyngeal Carcinoma

Zhou

Chen

Tao

et al. 2022

Journal of Oncology

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“…V45 = 50% is the threshold for hypothyroidism ( 17 ), and subsequent meta-analysis results additionally support this conclusion ( 18 ). However, some studies believe that V30 or V50 is the dose threshold for hypothyroidism ( 19 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

Multivariate NTCP Model of Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Shen

Peng

et al. 2021

Front. Oncol.

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ObjectiveTo 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 MethodsThe 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.ResultsA 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.ConclusionThe 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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“…The included studies were published from 2010 to 2021 across 13 countries, and all studies were observational in design. Nineteen studies provided comparative data on radiation dose-volume predictors (Table 1) [8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], while 10 studies reported radiation dosimetric nomograms or normal tissue complication probability (NTCP) models for post-radiation primary hypothyroidism (Table 2) [28][29][30][31][32][33][34][35][36][37]. The primary tumors were nasopharyngeal carcinoma (NPC), oropharyngeal carcinoma (OPC), and other sites in 41.4 % (12/29), 17.2 % (5/29), and 41.4 % (12/29) of the studies, respectively.…”

Section: Included Studiesmentioning

confidence: 99%

Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: A systematic review

Chow

Cheung

et al. 2022

Clinical and Translational Radiation Oncology

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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 dosevolume 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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Thyroid V50 is a risk factor for hypothyroidism in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a retrospective study

Cited by 16 publications

References 30 publications

Association between Cervical Lymph Node Metastasis and the Incidence of Radiation-Induced Hypothyroidism in Nasopharyngeal Carcinoma

Association between Cervical Lymph Node Metastasis and the Incidence of Radiation-Induced Hypothyroidism in Nasopharyngeal Carcinoma

Multivariate NTCP Model of Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: A systematic review

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