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Meme Kanserli Olgularda Adjuvan Radyoterapinin Tiroid Fonksiyonları Üzerine Etkisi

Year 2019, Volume: 29 Issue: 3, 124 - 129, 01.09.2019

Serap Çatlı Dinç Muhammed Ertuğrul Şentürk Niyazi Volkan Demircan Oya Akyol Diclehan Kılıç

Abstract

Amaç: Meme kanseri görülme sıklığı yıllar içerisinde artmasına rağmen meme kanserine bağlı ölüm oranlarında belirgin azalma dikkat çekmektedir. Buna bağlı olarak artan genel sağkalım süreleri, meme kanseri tedavisinde görülen yan etkilerin önemini arttırmıştır. Bu çalışmada meme kanseri nedeniyle adjuvan radyoterapi RT uygulanan olgularda, RT’nin tiroid fonksiyonlarına etkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bölümümüzde 2009-2017 yılları arasında meme kanseri nedeniyle RT uygulanmış 87 hastanın demografik verileri, tümör evreleri, tedavi modaliteleri, tiroid hacimleri, tedavi öncesi ve sonrası TSH, T3 ve T4 değerleri, RT doz ve hacimleri ile tiroid bezinin doz-volüm değerleri hasta dosyaları, planlama sistemi ve Gazi Üniversitesi Tıp Fakültesi elektronik veritabanından toplanarak değerlendirildi.Veriler SPSS 22.0 dosyasına aktarılarak hipotiroidizm ile RT doz-hacim, tiroid hacmi ilişkisi ki-kare ve parametrik olmayan testlerle analiz edildi.Bulgular: Medyan yaş 50 idi. 87 hastanın 85’i kadın %98 , 2 tanesi erkekti %2 . 59 hastanın metastatik lenf nodu %59 mevcuttu. 53 hastada %61 supraklaviküler alan SKF tedavi hacmi içerisindeydi. Toplamda 12 hastada 14% RT’ye bağlı hipotiroidizm görüldü. Lenf nodu pozitifliği, ve buna bağlı olarak yapılan SKF ışınlaması hipotiroidizm gelişmesi ile anlamlı olarak ilişkili saptandı sırasıyla p=0.013, p=0.003 . Çok değişkenli analizde sadece ortalama doz Dort=24Gy ve V30 %30 değerleri hipotiroidizm gelişmesi açısından istatistiksel olarak anlamlı bulundu sırasıyla p=0.038, p=0.044 . V30 değerlerinin >%30 olduğu olgularda hipotirodizm gelişme riskinin daha yüksek olduğu gözlendi p

Keywords

Tiroid Hipotiroidizm Radyoterapi Meme kanseri

References

  • Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J. Breast Can- cer: Epidemiology and Etiology. Cell Biochem Biophys 2015;72:333-8.
  • Swanick CW,Smith BD.Indications for adjuvant radiati- on therapy in breast cancer: a review of the evidence and recommendations for clinical practice.Chin Clin Oncol 2016;5:38.
  • Willner J, Kiricuta I, Kolbl O, Bohndorf W. Supraclavicu- lar lymph-node recurrence of breast-cancer. Oncol Rep 1994;1:1235-45.
  • Lindsay C. Brown, Robert W Mutter, Halyard MY. Benefits, risks, and safety of external beam radiation therapy for bre- ast cancer. Int J Womens Health 2015; 7: 449-58.
  • Alterio D, Jereczek-Fossa BA, Franchi B, D'Onofrio A, Pi- azzi V, Rondi E. Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients.Int J Radiat Oncol Biol Phys 2007;67:144-50.
  • Joensuu H, Viikari J.Thyroid function after postoperative radiation therapy in patients with breast cancer. Acta Radi- ol Oncol 1986;25:167-70.
  • GillettM. Subclinical Hypothyroidism: Subclinical Thyro- id Disease: Scientific Review and Guidelines for Diagnosis and Management. Clin Biochem Rev 2004; 25: 191–4.
  • Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ.. Es- timation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroi- dism and controls. J Clin Endocrinol Metab 1997;82:771-6.
  • Vigário P, Teixeira P, Reuters V, Almeida C, Maia M, Silva M, et al. Perceived health status of women with overt and subclinical hypothyroidism.Med Princ Pract 2009;18:317- 22.
  • Hall L.C,SalazarE. P.,KaneS. R.,Liu N. Effects of thyroid hormones on human breast cancer cell proliferation. J Ste- roid Biochem Mol Biol 2008;109:57-66.
  • Hancock SL, McDougall IR, Constine LS.Thyroid abnor- malities after therapeutic external radiation. Int J Radiat Oncol Biol Phys 1995;30:1165-70.
  • Akgun Z,Atasoy B M, Ozen Z , Yavuz D, Gulluoglu B ve ark. V30 as a predictor for radiation-induced hypothyroidism: a dosimetric analysis in patients who received radiotherapy to the neck. Radiation Oncology 2014;9:104.
  • Bruning P, Bonfrer J, Jong-Bakker M.D,Nooyen W, Bur- gers M. Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph nodes. Br J Cancer 1985;51:659–63.
  • Smith G.L., Smith B.D, Giordano S.H, Shih YC, Woo- dward WA, Strom EA et al. Risk of hypothyroidism in ol- der breast cancer patients treated with radiation. Cancer 2008;112:1371-9.
  • Johansen S.,Reinertsen K.V., Knutstad K., DR Olsen andSD Fosså. Dose distribution in the thyroid gland following ra- diation therapy of breast cancer-a retrospective study. Radi- at. Oncol 2011; 6:68.
  • Marks L,Yorke E, Jackson A, Haken R, Constine L, Eisbru- ch A, Bentzen S, Nam J, Deasy J.The Use of Normal Tissue Complication Probability (NTCP) Models in the Clinic. Int J Radiat Oncol Biol Phys 2010;76: 10–9.
  • Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenri- der JE, et al. Tolerance of normal tissue to therapeutic irra- diation.Int J Radiat Oncol Biol Phys 1991;21:109-22.
  • Cella L, Liuzzi R, Conson M, D'Avino V, Salvatore M, Pacel- li R.Development of multivariate NTCP models for radiati- on-induced hypothyroidism: a comparative analysis.Radiat Oncol 2012; 27:7-224.
  • Boomsma MJ, Bijl HP, Langendijk JA.Radiation-induced hypothyroidism in head and neck cancer patients: a syste- matic review. Radiother Oncol 2011; 99:1-5.
  • Cella L, Conson M, Caterino M, De Rosa N, Liuzzi R, Picar- di M, et al. Thyroid V30 predicts radiation-induced hypo- thyroidism in patients treated with sequential chemo-radi- otherapy for Hodgkin's lymphoma.Int J Radiat Oncol Biol Phys 2012;82:1802-8.
  • FujiwaraM,KamikonyaN, OdawaraS, Suzuki H, Niwa Y, Takada Y, et al. The threshold of hypothyroidism after ra- diation therapy for head and neck cancer: a retrospective analysis of 116 cases. J Radiat Res 2015;56: 577-82.
  • Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB. Thyroid V50 Highly Predictive of Hypothyroidism in Head-and-Neck Cancer Patients Treated With Inten- sity-modulated Radiotherapy (IMRT).Am J Clin Oncol 2017;40:413-7.
  • Kanyilmaz G, Aktan M, Koc M, Demir H, Demir LS. Ra- diation-induced hypothyroidism in patients with breast cancer: a retrospective analysis of 243 cases. Med Dosim 2017;42:190-6.
  • Kikawa Y, Kosaka Y2, Hashimoto K, Hohokabe E, Takebe S, Narukami R, et al. Prevalence of hypothyroidism among patients with breast cancer treated with radiation to the supraclavicular field: a single-centre survey. ESMO Open 2017; 27:e000161.
  • Tunio MA, A. Asiri M, Bayoumi Y, Stanciu LG, A. Johani N, A. Saeed EF. Is thyroid gland an organ at risk in breast can- cer patients treated with locoregional radiotherapy? Results of a pilot study.J Cancer Res Ther 2015; 4:684-9.

Year 2019, Volume: 29 Issue: 3, 124 - 129, 01.09.2019

Serap Çatlı Dinç Muhammed Ertuğrul Şentürk Niyazi Volkan Demircan Oya Akyol Diclehan Kılıç

Abstract

Objective: Despite the increasing incidence of breast cancer, mortality ratio due to the disease is prominently reduced so far.In this regard, prolonged overall survival is required to focus on side effects of breast cancer treatment more seriously. To evaluate the effect of adjuvant radiotheraphy RT on thyroid gland functions in breast cancer patients was aimed.Material and Methods: Demographic data of patients, tumor stages, treatment modalities, thyroid volumes, pre- and posttreatment TSH, T3 and T4 values, RT dose and volumes and dose volume values of the thyroid gland of 87 breast cancer patients were collected from patients files, planning system and Gazi University Medical Faculty electronic database and analyzed. Statistical analysis was done to detect between the RT dose volume parameters and hypothyroidism.Results: Median age was 50 years. Of the 87 patients, 98%were female. 59%had metastatic lymph nodes. In 53 patients, supraclavicular area SCF was in the treatment volume.Radiation-related hypothyroidism was detected in 14%.Lymph node involvement and consequent SCF irradiation were found to be associated with the development of hypothyroidism p = 0.013, p = 0.003, respectively . Onlymean dose Dmean=24 Gy and volume of 30 Gy V30 valueswere found statistically significant on the development of hypothyroidism in multivariate analysis p = 0.038, p = 0.044, respectively . Risk of hypothyroidism due to RT were seemed higher in patients with V30 ≥ 30 % values of thyroid gland volume p

Keywords

Thyroid Hypothyroidism Radiotheraphy Breast cancer

References

  • Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J. Breast Can- cer: Epidemiology and Etiology. Cell Biochem Biophys 2015;72:333-8.
  • Swanick CW,Smith BD.Indications for adjuvant radiati- on therapy in breast cancer: a review of the evidence and recommendations for clinical practice.Chin Clin Oncol 2016;5:38.
  • Willner J, Kiricuta I, Kolbl O, Bohndorf W. Supraclavicu- lar lymph-node recurrence of breast-cancer. Oncol Rep 1994;1:1235-45.
  • Lindsay C. Brown, Robert W Mutter, Halyard MY. Benefits, risks, and safety of external beam radiation therapy for bre- ast cancer. Int J Womens Health 2015; 7: 449-58.
  • Alterio D, Jereczek-Fossa BA, Franchi B, D'Onofrio A, Pi- azzi V, Rondi E. Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients.Int J Radiat Oncol Biol Phys 2007;67:144-50.
  • Joensuu H, Viikari J.Thyroid function after postoperative radiation therapy in patients with breast cancer. Acta Radi- ol Oncol 1986;25:167-70.
  • GillettM. Subclinical Hypothyroidism: Subclinical Thyro- id Disease: Scientific Review and Guidelines for Diagnosis and Management. Clin Biochem Rev 2004; 25: 191–4.
  • Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ.. Es- timation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroi- dism and controls. J Clin Endocrinol Metab 1997;82:771-6.
  • Vigário P, Teixeira P, Reuters V, Almeida C, Maia M, Silva M, et al. Perceived health status of women with overt and subclinical hypothyroidism.Med Princ Pract 2009;18:317- 22.
  • Hall L.C,SalazarE. P.,KaneS. R.,Liu N. Effects of thyroid hormones on human breast cancer cell proliferation. J Ste- roid Biochem Mol Biol 2008;109:57-66.
  • Hancock SL, McDougall IR, Constine LS.Thyroid abnor- malities after therapeutic external radiation. Int J Radiat Oncol Biol Phys 1995;30:1165-70.
  • Akgun Z,Atasoy B M, Ozen Z , Yavuz D, Gulluoglu B ve ark. V30 as a predictor for radiation-induced hypothyroidism: a dosimetric analysis in patients who received radiotherapy to the neck. Radiation Oncology 2014;9:104.
  • Bruning P, Bonfrer J, Jong-Bakker M.D,Nooyen W, Bur- gers M. Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph nodes. Br J Cancer 1985;51:659–63.
  • Smith G.L., Smith B.D, Giordano S.H, Shih YC, Woo- dward WA, Strom EA et al. Risk of hypothyroidism in ol- der breast cancer patients treated with radiation. Cancer 2008;112:1371-9.
  • Johansen S.,Reinertsen K.V., Knutstad K., DR Olsen andSD Fosså. Dose distribution in the thyroid gland following ra- diation therapy of breast cancer-a retrospective study. Radi- at. Oncol 2011; 6:68.
  • Marks L,Yorke E, Jackson A, Haken R, Constine L, Eisbru- ch A, Bentzen S, Nam J, Deasy J.The Use of Normal Tissue Complication Probability (NTCP) Models in the Clinic. Int J Radiat Oncol Biol Phys 2010;76: 10–9.
  • Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenri- der JE, et al. Tolerance of normal tissue to therapeutic irra- diation.Int J Radiat Oncol Biol Phys 1991;21:109-22.
  • Cella L, Liuzzi R, Conson M, D'Avino V, Salvatore M, Pacel- li R.Development of multivariate NTCP models for radiati- on-induced hypothyroidism: a comparative analysis.Radiat Oncol 2012; 27:7-224.
  • Boomsma MJ, Bijl HP, Langendijk JA.Radiation-induced hypothyroidism in head and neck cancer patients: a syste- matic review. Radiother Oncol 2011; 99:1-5.
  • Cella L, Conson M, Caterino M, De Rosa N, Liuzzi R, Picar- di M, et al. Thyroid V30 predicts radiation-induced hypo- thyroidism in patients treated with sequential chemo-radi- otherapy for Hodgkin's lymphoma.Int J Radiat Oncol Biol Phys 2012;82:1802-8.
  • FujiwaraM,KamikonyaN, OdawaraS, Suzuki H, Niwa Y, Takada Y, et al. The threshold of hypothyroidism after ra- diation therapy for head and neck cancer: a retrospective analysis of 116 cases. J Radiat Res 2015;56: 577-82.
  • Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB. Thyroid V50 Highly Predictive of Hypothyroidism in Head-and-Neck Cancer Patients Treated With Inten- sity-modulated Radiotherapy (IMRT).Am J Clin Oncol 2017;40:413-7.
  • Kanyilmaz G, Aktan M, Koc M, Demir H, Demir LS. Ra- diation-induced hypothyroidism in patients with breast cancer: a retrospective analysis of 243 cases. Med Dosim 2017;42:190-6.
  • Kikawa Y, Kosaka Y2, Hashimoto K, Hohokabe E, Takebe S, Narukami R, et al. Prevalence of hypothyroidism among patients with breast cancer treated with radiation to the supraclavicular field: a single-centre survey. ESMO Open 2017; 27:e000161.
  • Tunio MA, A. Asiri M, Bayoumi Y, Stanciu LG, A. Johani N, A. Saeed EF. Is thyroid gland an organ at risk in breast can- cer patients treated with locoregional radiotherapy? Results of a pilot study.J Cancer Res Ther 2015; 4:684-9.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Original Article
Authors

Serap Çatlı Dinç This is me

Muhammed Ertuğrul Şentürk This is me

Niyazi Volkan Demircan This is me

Oya Akyol This is me

Diclehan Kılıç This is me

Publication Date September 1, 2019
Published in Issue Year 2019 Volume: 29 Issue: 3

Cite

Vancouver Çatlı Dinç S, Şentürk ME, Demircan NV, Akyol O, Kılıç D. Meme Kanserli Olgularda Adjuvan Radyoterapinin Tiroid Fonksiyonları Üzerine Etkisi. Genel Tıp Derg. 2019;29(3):124-9.

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