A New Model for Predicting Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Peng, Liang; Mao, Yan‐Ping; Huang, Cheng‐Long; Guo, Rui; Ma, Jun; Wang, Wen; Tang, Ling-Long

doi:10.3389/fonc.2020.551255

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…Radiotherapy-induced hypothyroidism (RHT) is one of the common late-stage toxic reactions in patients who have received cervical radiotherapy, and its incidence is as high as 20%–40% ( 1 – 3 ), which is higher than the incidence in the normal population. The occurrence of hypothyroidism after radiotherapy in most studies was concentrated within 5 years after radiotherapy, and it generally reached a peak approximately 1 to 3 years after radiotherapy ( 4 – 6 ).…”

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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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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“…The crude incidence of post-radiation hypothyroidism exceeded 30 % in 11 studies in which the median follow-up duration was longer than 3 years [10,14,17,18,[20][21][22][23][24]. Sixteen of 29 studies (55 %) reported the median time to hypothyroidism [8,11,13,15,17,[20][21][22]24,26,28,[30][31][32][33]37]. Hypothyroidism occurred at a median of 1.1 years (range, 0.7-3.1 years) after head and neck radiotherapy.…”

Section: Incidence Of Post-radiation Hypothyroidismmentioning

confidence: 99%

“…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%

“…The crude incidence of post-radiation hypothyroidism was reported in 27 of 29 studies [8,[10][11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36][37]. Patient samples overlapped in two studies; thus, we included the study with the larger sample size only in incidence analyses [31,32].…”

Section: Incidence Of Post-radiation Hypothyroidismmentioning

confidence: 99%

“…The relationships between thyroid radiation dose-volume parameters and the subsequent risk of hypothyroidism were reported in 19 studies [8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In all studies, thyroid dosimetry was evaluated using computed tomography (CT)-based radiotherapy planning systems.…”

Section: Radiation Dose-volume Predictorsmentioning

confidence: 99%

See 2 more Smart Citations

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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Risk factors of early thyroid dysfunction after definitive radiotherapy in nasopharyngeal carcinoma patients

et al. 2023

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BackgroundTo explore the patterns and risk factors of early thyroid dysfunction in nasopharyngeal carcinoma (NPC) patients within 1 year after intensity‐modulated radiation therapy (IMRT).MethodsPatients with NPC who received definitive IMRT between April 2016 and April 2020 were included. All patients had normal thyroid function before definitive IMRT. The chi‐square test, Student's T‐test, Mann–Whitney U test, Kaplan–Meier method, receiver operating characteristics curve, and Cox proportional hazard analysis were used for statistical analysis.ResultsA total of 132 NPC patients were identified. Of these patients, 56 (42.4%) had hypothyroidism and 17 (12.9%) had hyperthyroidism. The median time to hypothyroidism and hyperthyroidism was 9 months (range, 1–12 months) and 1 month (range, 1–6 months) after definitive IMRT, respectively. In patients with hypothyroidism, 41 (73.2%) had subclinical hypothyroidism and 15 (26.8%) had clinical hypothyroidism. In those with hyperthyroidism, 12 patients (70.6%) had subclinical hyperthyroidism, and five patients (29.4%) had clinical hyperthyroidism. Age, clinical stage, thyroid volume, and V45 were independent risk factors for early radiation‐induced hypothyroidism within 1 year after IMRT. Patients aged <47 years, stage III/IV disease, or pre‐irradiation thyroid volume < 14 cm3 had higher risks of developing hypothyroidism.ConclusionPrimary subclinical hypothyroidism was the most common subtype of early thyroid dysfunction in NPC patients within 1 year after IMRT. Age, clinical stage, thyroid volume, and V45 were independent risk factors for early radiation‐induced hypothyroidism in NPC patients.

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A New Model for Predicting Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Cited by 15 publications

References 22 publications

Multivariate NTCP Model of Hypothyroidism After Intensity-Modulated Radiotherapy for 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

Risk factors of early thyroid dysfunction after definitive radiotherapy in nasopharyngeal carcinoma patients

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