Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer

El-Shebiney, Mohamed; Elmashad, Nehal; Elmashad, Wael; El-Ebiary, Ahmed A.; Kotkat, Abdallah E.

doi:10.1016/j.jnci.2018.01.004

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…Also, the retrospective nature of some studies contributed to this variation. Using 3DCRT alone like our study and El-Sherbiney et al study [16] may contribute to different outcomes than using IMRT in other studies [2,14,15,28].…”

Section: Discussionmentioning

confidence: 54%

“…Our results have shown that the incidence of RIHT after maximum follow up of 24 months was 26%. The range of reported incidence from similar studies ranged from 17-47% [2,5,15,16,18,19]. Our follow up period is relatively short and the incidence is expected to increase with longer follow up periods.…”

Section: Discussionmentioning

confidence: 84%

“…The current study is a prospective study while all of these studies were retrospective studies. Other prospective studies [16,17] showed that patient age, sex, comorbidities, combined surgery , and concurrent chemotherapy did not contribute to the risk of RIHT.…”

Section: Discussionmentioning

confidence: 92%

“…No dose constraints to the thyroid gland were adopted and therefore the thyroid gland was not actively protected from higher doses of radiation. A similar radiotherapy technique was taken by El-Sherbiney et al [16]. However, IMRT was used in other studies like [14,17].…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have defined V 30 > 62.6% [19], V 30 > 42.1% [16], D 50 of 44 Gy [27], V 50 > 60% [20] as the threshold for RIHT. Mean dose ≥ 50 Gy was considered a considerable cutoff [2].…”

Section: Discussionmentioning

confidence: 99%

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Dose-volumetric Predictors for Thyroid Dysfunction after 3D Conformal Radiotherapy: An Observational, Prospective Study

AlJamal

El-Naby

El‐Badrawy

et al. 2020

JCTI

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Aim: This study was conducted to assess the dose-volumetric threshold of radiation induced hypothyroidism (RIHT) in patients receiving radiotherapy (RT) to the neck. Study Design: This is a prospective cohort observational study. Place and Duration of the Study: The study was conducted at Mansoura University Hospital, Mansoura, Egypt, between April 2016 until March 2019. Methods: We have completed 2 years of follow up to 50 patients with different malignancies who were treated by radiotherapy to the neck. Baseline assessment of the thyroid clinically and radiologically was done prior to the start of radiotherapy. Periodic testing of the cohort through the follow up period was done by clinical examination, measurement of TSH, fT4 and thyroid ultrasonography. Results: the incidence of RIHT was 26%. No statistical significance for the clinical risk factors. The dose-volumetric risk factors were studied and showed positive results. A mean dose of 5185 cGy was found a significant risk factor. Also, V40 ≥ 89%, V45 ≥ 63.5%, V50 ≥ 22.5% were found to be the cutoff predictors for the threshold radiation dose to induce hypothyroidism. Also decreasing the size of the gland by ≥0.7 cm3, fT4 value by ≥ 3.5 pmol/L and TSH by ≥ 0.75 uIU/L after one year from the end of EBRT is the cutoff value for prediction of occurrence of RIHT within the 2nd year of follow up. Conclusion: RIHT is a considerable late adverse effect for patients receiving RT to the neck. Mean dose, V40, V45 and V50 were found significantly related to RIHT. Mean dose of ≥ 5185 cGy, V40 ≥ 89%, V45 ≥ 63.5%, V50≥ 22.5% were proven to be the dose-volumetric threshold.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dose-volumetric Predictors for Thyroid Dysfunction after 3D Conformal Radiotherapy: An Observational, Prospective Study

AlJamal

El-Naby

El‐Badrawy

et al. 2020

JCTI

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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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Post-radiation primary hypothyroidism in patients with head and neck cancer: External validation of thyroid gland dose–volume constraints with long-term endocrine outcomes

Chow

Lui

Cheung

et al. 2022

Radiotherapy and Oncology

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Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer

Abstract: The V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.

Cited by 6 publications

References 26 publications

Dose-volumetric Predictors for Thyroid Dysfunction after 3D Conformal Radiotherapy: An Observational, Prospective Study

Dose-volumetric Predictors for Thyroid Dysfunction after 3D Conformal Radiotherapy: An Observational, Prospective Study

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

Post-radiation primary hypothyroidism in patients with head and neck cancer: External validation of thyroid gland dose–volume constraints with long-term endocrine outcomes

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