Hormonal dysfunction is frequent in cancer survivors treated with radiotherapy to the head and neck region

Seland, Mette; Bjøro, Trine; Furre, Torbjørn; Schreiner, Thomas; Bollerslev, Jens; Fosså, Sophie D.; Loge, Jon Håvard; Holte, Harald; Kiserud, Cecilie E.

doi:10.1007/s11764-015-0439-x

Cited by 12 publications

(12 citation statements)

References 34 publications

(54 reference statements)

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“…Apart from neurocognitive decline, another common sequela of cranial radiation therapy is functional endocrine impairment due to critical doses to the hypothalamus and the pituitary gland. A significant percentage of patients with brain tumors [10][11][12] and head and neck cancer [13][14][15] develop hormonal deficiencies after radiotherapy. At the time of our research period, endocrine follow-up data after WBRT was scarce.…”

Section: Introductionmentioning

confidence: 99%

Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study

et al. 2020

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Background: Feasibility testing of a simultaneous sparing approach of hippocampus, hypothalamus and pituitary gland in patients undergoing whole-brain radiotherapy (WBRT) with and without a concomitant boost to metastatic sites. Introduction: Cognitive impairment and hormonal dysfunction are common side effects of cranial radiotherapy. A reduced dose application to the patho-physiologically involved functional brain areas, i.e. hippocampus, hypothalamus and pituitary gland, could reduce these common side effects. While hippocampal sparing is already a common practice to improve cognitive outcome, technical experience of additional combined sparing of the hypothalamus/pituitary gland (HT-P) is insufficient. Methods: Twenty patients were included in the planning study. In 11 patients, a total dose of 36 Gy of WBRT (2 Gy per fraction) plus a simultaneous integrated boost (SIB) of 9 Gy (0.5 Gy per fraction, total dose: 45 Gy) to the brain metastases was applied. In 9 patients, prophylactic cranial irradiation (PCI) was simulated with a total dose of 30 Gy (2 Gy per fraction). In both patient cohorts, a sparing approach of the hippocampus and the HT-P area was simulated during WBRT. For all treatment plans, volumetric modulated arc therapy (VMAT) was used. Quality assurance included assessment of homogeneity, conformality and target coverage. Results: The mean dose to the hippocampus and HT-P region was limited to less than 50% of the prescribed dose to the planning target volume (PTV) in all treatment plans. Dose homogeneity (HI) of the target volume was satisfying (median HI = 0.16 for WBRT+SIB and 0.1 for PCI) and target coverage (conformation number, CN) was not compromised (median CN = 0.82 for SIB and 0.86 for PCI).

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Section: Introductionmentioning

confidence: 99%

Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study

et al. 2020

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“…Isolated growth hormone deficiency (GHD) is induced by doses of 18-24Gy [16]. There is a significant relationship between pituitary dysfunction and radiation doses of 30Gy or higher [17].…”

Section: Radiation-induced Hypopituitarismmentioning

confidence: 99%

“…Untreated hypothyroidism can lead to heart failure, psychosis and coma, and may reduce the effectiveness of life-saving cancer treatments, while iatrogenic causes can lead to atrial fibrillation and osteoporosis [80]. In addition to the increased risk of hypothyroidism, clinicians need to be aware that brain cancer survivors who have received thyroid radiation during childhood and adolescence also have an increased risk of developing thyroid cancer [17].…”

Section: Thyroid Disordersmentioning

confidence: 99%

Endocrine Late Effects of Radiation Therapy in Pediatric and Young Adult Patients with Brain Tumors

Li¹,

Yang²,

Shi³

et al. 2023

MJCS

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With the improvement of treatment techniques, the survival rate for childhood and young adults with brain tumors has increased over the last 40 years. Endocrine late effects account for a large portion of the negative consequences in childhood brain tumor survivors. Treatment of childhood and young adult brain tumors, including radiation therapy, surgery, chemotherapy and other therapeutic techniques often results in endocrine late effects manifested by hypopituitarism, which can involve growth hormone deficiency, hypothyroidism, adrenal insufficiency, gonad disorders, diabetes insipidus, and metabolic complications. A literature search was conducted on Medline including longitudinal controlled studies, retrospective cohort studies, systematic reviews, recent evidence-based guidelines, meta-analyses, and case reports. An updated review of the latest results and analyses was provided on radiation-induced endocrine sequelae of brain tumor survivors in children and young adults.Endocrine late effects can occur many years after the initial radiation treatment of a brain tumor, so surveillance of growth, weight, puberty, bone age development, and endocrine status is recommended every 6 months to 2 years after tumor therapy. Pediatric and young adult survivors with brain tumors are important follow-up subjects. Early diagnosis and appropriate treatment may improve health outcomes. Newer radiation treatment techniques, such as proton radiotherapy, can reduce endocrine complications, but this benefit has not been proven as additional research is needed on short-term and long-term results.

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“…The probable pathophysiological mechanisms underlying the thyroid hypofunction observed in the present study are not fully understood. Disturbance of the thyroid hormonal axis is a common AHO after RT to the head and neck region affecting both the central pituitary axis (secondary dysfunction) and the thyroid gland (primary dysfunction) [6,9]. However, in TCSs radiotoxic effect causing secondary or primary thyroid dysfunction, is less likely as both the pituitary and thyroid glands are distant to the RT target region.…”

Section: Adverse Health Outcomes In Tcssmentioning

confidence: 99%

“…However, the prevalence of thyroid dysfunction in this group of cancer survivors is largely unknown, except for a few studies with conflicting results [2][3][4][5]. Thyroid hypofunction is an AHO encountered after radiotherapy (RT) in Hodgkin's lymphoma and breast cancer survivors where radiation to the thyroid gland is supposed to be the culprit [6][7][8][9]. Chemotherapy applied in combination with RT to the head and neck region may have a synergistic effect, but chemotherapy per se is seldom suspected to cause thyroid hypofunction [7].…”

Section: Introductionmentioning

confidence: 99%

Thyroid hypofunction in aging testicular cancer survivors

et al. 2021

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Purpose: Thyroid hypofunction is a late effect observed in several groups of cancer survivors, but has to date not been evaluated in-depth in testicular cancer survivors (TCSs). We investigated the prevalence of thyroid hypofunction in long-term TCSs and compared the findings with those of a comparison group from the general population. Patients and Methods: Norwegian TCSs diagnosed with unilateral testicular cancer in the period 1980-1994 (N ¼ 1,436) were grouped according to their cancer treatment (Surgery only; Radiotherapy only; Cisplatin-based chemotherapy, eventually combined with radiotherapy). They were invited to participate in three surveys covering up to three decades post-diagnosis. Serum thyrotropin (s-TSH) from samples collected from the last survey were analyzed. S-TSH results were also available from a health survey of the general population performed in a county in mid-Norway (the HUNT3 Survey [comparison group]). Data on the prescription of thyroid hormone replacement therapy (levothyroxine) from the Norwegian Prescription Database were obtained for the TCSs and the comparison group's participants. Thyroid hypofunction was defined as 'untreated' (overt or subclinical) hypothyroidism (with s-TSH 3.5 mIU/L and no regular prescription of levothyroxine) or 'treated' hypothyroidism with regular prescription of levothyroxine. Results: Three decades after diagnosis the prevalence of thyroid hypofunction (i.e., both treated and untreated) was 11% in the TCSs and the prevalence ratio was 1.9 indicating an almost doubled prevalence in the TCSs compared to the comparison group (prevalence ratio 1.91, 95% CI [1.54; 2.38]). However, there were no significant differences in the risk of thyroid hypofunction related to the TCSs' treatment modality. Conclusion: TCSs may have an increased prevalence of thyroid hypofunction compared to the general population. Hypothyroidism has negative consequences related both to primary hypogonadism and to cardiovascular disease. As both conditions are overrepresented in TCSs, regular monitoring of thyroid hormones may be advisable.

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Hormonal dysfunction is frequent in cancer survivors treated with radiotherapy to the head and neck region

Abstract: Screening for hormonal dysfunction during follow-up might be indicated.

Cited by 12 publications

References 34 publications

Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study

Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study

Endocrine Late Effects of Radiation Therapy in Pediatric and Young Adult Patients with Brain Tumors

Thyroid hypofunction in aging testicular cancer survivors

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