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Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?

Year 2017, Volume: 27 Issue: 6, 269 - 275, 20.12.2017

Abstract

Objectives: This study aims to analyze the incidence of hypothyroidism HT in patients who underwent radiotherapy RT for head and neck cancers HNC , and to determine risk factors. Patients and Methods: This study was a retrospective analysis of patients who were treated with RT alone or in combination with surgery and/or chemotherapy between January 2005 and May 2012. Patients were grouped according to the primary tumor site, TNM staging system, age, gender, total radiation dose TRD , mean radiation dose of thyroid gland MRT , neck dissection, and chemotherapy. Results: A total of 90 patients who were treated with RT were analyzed. The median age was 52±13 range, 12-87 years. The histopathologic finding of 88 patients was squamous cell carcinoma, others were adenocystic carcinoma and undifferentiated carcinoma. The median follow-up of all patients after RT was 15 range, 6-72 months. Post-radiotherapy HT was found in 31 patients 34.4% . In this group, clinical and subclinical HT was present in eight 26% and 23 74% patients, respectively. Age younger than 60 years and increased MRT especially mean thyroid dose 20 Gy< were significant risk factors for post-radiotherapy HT p<0.05 . Conclusion: Physicians should pay more attention to HT in patients who were treated with RT for HNC during follow-up.

References

  • Posner MR. Options in the Treatment of Head and Neck Cancer. Oncology News International; 2006.
  • Turner SL, Tiver KW, Boyages SC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1995;31:279-83.
  • Murthy V, Narang K, Ghosh-Laskar S, Gupta T, Budrukkar A, Agrawal JP. Hypothyroidism after 3-dimensional conformal radiotherapy and intensity- modulated radiotherapy for head and neck cancers: prospective data from 2 randomized controlled trials. Head Neck 2014;36:1573-80.
  • Smith GL, Smith BD, Garden AS, Rosenthal DI, Sherman SI, Morrison WH, et al. Hypothyroidism in older patients with head and neck cancer after treat- ment with radiation: a population-based study. Head Neck 2009;31:1031-8.
  • Kim MY, Yu T, Wu HG. Dose-volumetric parameters for predicting hypothyroidism after radiotherapy for head and neck cancer. Jpn J Clin Oncol 2014;44:331-7.
  • Rİnjom MF, Brink C, Bentzen SM, Hegedüs L, Overgaard J, Johansen J. Hypothyroidism after pri- mary radiotherapy for head and neck squamous cell carcinoma: normal tissue complication probability modeling with latent time correction. Radiother Oncol 2013;109:317-22.
  • Alterio D, Jereczek-Fossa BA, Franchi B, D'Onofrio A, Piazzi V, Rondi E, et al. 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.
  • Starks TJ, Payton G, Golub SA, Weinberger CL, Parsons JT. Contextualizing condom use: intimacy interfer- ence, stigma, and unprotected sex. J Health Psychol 2014;19:711-20.
  • Jereczek-Fossa BA, Alterio D, Jassem J, Gibelli B, Tradati N, Orecchia R. Radiotherapy-induced thyroid disorders. Cancer Treat Rev 2004;30:369-84.
  • Miller MC, Agrawal A. Hypothyroidism in postradia- tion head and neck cancer patients: incidence, compli- cations, and management. Curr Opin Otolaryngol Head Neck Surg 2009;17:111-5.
  • Fajardo LF, Berthrong M, Anderson RE. Radiation pathology. Oxford University Press; 2001.
  • Hellman S, Botnick LE. Stem cell depletion: an expla- nation of the late effects of cytotoxins. Int J Radiat Oncol Biol Phys 1977;2:181-4.
  • Tell R, Sjödin H, Lundell G, Lewin F, Lewensohn R. Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1997;39:303-8.
  • Bernát L, Hrušák D. Hypothyroidism after radiother- apy of head and neck cancer. J Craniomaxillofac Surg 2014;42:356-61.
  • Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myo- cardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-8.
  • Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002;137:904-14.
  • Tell R, Lundell G, Nilsson B, Sjödin H, Lewin F, Lewensohn R. Long-term incidence of hypothyroid- ism after radiotherapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004;60:395-400.
  • Boomsma MJ, Bijl HP, Langendijk JA. Radiation- induced hypothyroidism in head and neck can- cer patients: a systematic review. Radiother Oncol 2011;99:1-5.
  • Diaz R, Jaboin JJ, Morales-Paliza M, Koehler E, Phillips JG, Stinson S, et al. Hypothyroidism as a consequence of intensity-modulated radiotherapy with concur- rent taxane-based chemotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;77:468-76.
  • Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin's disease. N Engl J Med 1991;325:599-605.
  • Bhandare N, Kennedy L, Malyapa RS, Morris CG, Mendenhall WM. Primary and central hypothyroid- ism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys 2007;68:1131-9.
  • Colevas AD, Read R, Thornhill J, Adak S, Tishler R, Busse P, et al. Hypothyroidism incidence after multi- modality treatment for stage III and IV squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 2001;51:599-604.
  • Mercado G, Adelstein DJ, Saxton JP, Secic M, Larto MA, Lavertu P. Hypothyroidism: a frequent event after radiotherapy and after radiotherapy with che- motherapy for patients with head and neck carcinoma. Cancer 2001;92:2892-7.
  • Lochhead JNM. Care of the patient in radiotherapy. Wiley-Blackwell; 1983.
  • Wu YH, Wang HM, Chen HH, Lin CY, Chen EY, Fan KH, et al. Hypothyroidism after radiotherapy for nasopharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2010;76:1133-9.
  • Garcia-Serra A, Amdur RJ, Morris CG, Mazzaferri E, Mendenhall WM. Thyroid function should be moni- tored following radiotherapy to the low neck. Am J Clin Oncol 2005;28:255-8.
  • Palmer BV, Gaggar N, Shaw HJ. Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx. Head Neck Surg 1981;4:13-5.
  • Paulino AC. Hypothyroidism in children with medul- loblastoma: a comparison of 3600 and 2340 cGy cra- niospinal radiotherapy. Int J Radiat Oncol Biol Phys 2002;53:543-7.

Baş-boyun kanserlerinde radyoterapi sonrası hipotiroidi: Ne zaman endişelenmeliyiz?

Year 2017, Volume: 27 Issue: 6, 269 - 275, 20.12.2017

Abstract

Amaç: Bu çalışmada, baş-boyun kanserlerinde HNC radyoterapi RT uygulanan hastalarda hipotiroidi HT insidansının analiz edilmesi ve risk faktörlerinin belirlenmesi amaçlandı.Hastalar ve Yöntemler: Bu çalışma, Ocak 2005 - Mayıs 2012 tarihleri arasında tek başına RT ile tedavi edilen veya cerrahi veya kemoterapi ile kombine edilen hastaların retrospektif bir analizidir. Hastalar primer tümör, TNM evreleme sistemi, yaş, cinsiyet, total radyasyon dozu TRD , tiroid bezinin ortalama radyasyon dozu MRT , boyun diseksiyonu uygulaması ve kemoterapiye göre gruplandırıldı.Bulgular: Radyoterapi ile tedavi edilen toplam 90 hasta analiz edildi. Medyan yaş 52±13 yıl idi. Seksen sekiz hastanın histopatolojik bulgusu skuamöz hücreli karsinom, diğerleri adenokistik karsinom ve indifferansiye karsinom idi. Radyoterapi sonrası tüm hastaların medyan takip süresi 15 ay idi. Post-radyoterapi HT, 31 hastada %34.4 bulundu. Bu grupta sırasıyla sekiz %26 ve 23 %74 hastada klinik ve subklinik HT vardı. Altmış yaşın altındaki yaş ve MRT artışı özellikle ortalama tiroid dozu 20 Gy< , radyoterapi sonrası HT için anlamlı risk faktörleri idi p

References

  • Posner MR. Options in the Treatment of Head and Neck Cancer. Oncology News International; 2006.
  • Turner SL, Tiver KW, Boyages SC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1995;31:279-83.
  • Murthy V, Narang K, Ghosh-Laskar S, Gupta T, Budrukkar A, Agrawal JP. Hypothyroidism after 3-dimensional conformal radiotherapy and intensity- modulated radiotherapy for head and neck cancers: prospective data from 2 randomized controlled trials. Head Neck 2014;36:1573-80.
  • Smith GL, Smith BD, Garden AS, Rosenthal DI, Sherman SI, Morrison WH, et al. Hypothyroidism in older patients with head and neck cancer after treat- ment with radiation: a population-based study. Head Neck 2009;31:1031-8.
  • Kim MY, Yu T, Wu HG. Dose-volumetric parameters for predicting hypothyroidism after radiotherapy for head and neck cancer. Jpn J Clin Oncol 2014;44:331-7.
  • Rİnjom MF, Brink C, Bentzen SM, Hegedüs L, Overgaard J, Johansen J. Hypothyroidism after pri- mary radiotherapy for head and neck squamous cell carcinoma: normal tissue complication probability modeling with latent time correction. Radiother Oncol 2013;109:317-22.
  • Alterio D, Jereczek-Fossa BA, Franchi B, D'Onofrio A, Piazzi V, Rondi E, et al. 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.
  • Starks TJ, Payton G, Golub SA, Weinberger CL, Parsons JT. Contextualizing condom use: intimacy interfer- ence, stigma, and unprotected sex. J Health Psychol 2014;19:711-20.
  • Jereczek-Fossa BA, Alterio D, Jassem J, Gibelli B, Tradati N, Orecchia R. Radiotherapy-induced thyroid disorders. Cancer Treat Rev 2004;30:369-84.
  • Miller MC, Agrawal A. Hypothyroidism in postradia- tion head and neck cancer patients: incidence, compli- cations, and management. Curr Opin Otolaryngol Head Neck Surg 2009;17:111-5.
  • Fajardo LF, Berthrong M, Anderson RE. Radiation pathology. Oxford University Press; 2001.
  • Hellman S, Botnick LE. Stem cell depletion: an expla- nation of the late effects of cytotoxins. Int J Radiat Oncol Biol Phys 1977;2:181-4.
  • Tell R, Sjödin H, Lundell G, Lewin F, Lewensohn R. Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1997;39:303-8.
  • Bernát L, Hrušák D. Hypothyroidism after radiother- apy of head and neck cancer. J Craniomaxillofac Surg 2014;42:356-61.
  • Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myo- cardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-8.
  • Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002;137:904-14.
  • Tell R, Lundell G, Nilsson B, Sjödin H, Lewin F, Lewensohn R. Long-term incidence of hypothyroid- ism after radiotherapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004;60:395-400.
  • Boomsma MJ, Bijl HP, Langendijk JA. Radiation- induced hypothyroidism in head and neck can- cer patients: a systematic review. Radiother Oncol 2011;99:1-5.
  • Diaz R, Jaboin JJ, Morales-Paliza M, Koehler E, Phillips JG, Stinson S, et al. Hypothyroidism as a consequence of intensity-modulated radiotherapy with concur- rent taxane-based chemotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;77:468-76.
  • Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin's disease. N Engl J Med 1991;325:599-605.
  • Bhandare N, Kennedy L, Malyapa RS, Morris CG, Mendenhall WM. Primary and central hypothyroid- ism after radiotherapy for head-and-neck tumors. Int J Radiat Oncol Biol Phys 2007;68:1131-9.
  • Colevas AD, Read R, Thornhill J, Adak S, Tishler R, Busse P, et al. Hypothyroidism incidence after multi- modality treatment for stage III and IV squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 2001;51:599-604.
  • Mercado G, Adelstein DJ, Saxton JP, Secic M, Larto MA, Lavertu P. Hypothyroidism: a frequent event after radiotherapy and after radiotherapy with che- motherapy for patients with head and neck carcinoma. Cancer 2001;92:2892-7.
  • Lochhead JNM. Care of the patient in radiotherapy. Wiley-Blackwell; 1983.
  • Wu YH, Wang HM, Chen HH, Lin CY, Chen EY, Fan KH, et al. Hypothyroidism after radiotherapy for nasopharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2010;76:1133-9.
  • Garcia-Serra A, Amdur RJ, Morris CG, Mazzaferri E, Mendenhall WM. Thyroid function should be moni- tored following radiotherapy to the low neck. Am J Clin Oncol 2005;28:255-8.
  • Palmer BV, Gaggar N, Shaw HJ. Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx. Head Neck Surg 1981;4:13-5.
  • Paulino AC. Hypothyroidism in children with medul- loblastoma: a comparison of 3600 and 2340 cGy cra- niospinal radiotherapy. Int J Radiat Oncol Biol Phys 2002;53:543-7.
There are 28 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Mehmet Çelik This is me

Rasim Meral This is me

Deniz Kanlıada This is me

Levent Aydemir This is me

Bora Başaran This is me

Erkan Kıyak This is me

Publication Date December 20, 2017
Published in Issue Year 2017 Volume: 27 Issue: 6

Cite

APA Çelik, M., Meral, R., Kanlıada, D., Aydemir, L., et al. (2017). Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?. The Turkish Journal of Ear Nose and Throat, 27(6), 269-275.
AMA Çelik M, Meral R, Kanlıada D, Aydemir L, Başaran B, Kıyak E. Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?. Tr-ENT. December 2017;27(6):269-275.
Chicago Çelik, Mehmet, Rasim Meral, Deniz Kanlıada, Levent Aydemir, Bora Başaran, and Erkan Kıyak. “Post-Radiotherapy Hypothyroidism in Head and Neck Cancers: When Should We Be Concerned?”. The Turkish Journal of Ear Nose and Throat 27, no. 6 (December 2017): 269-75.
EndNote Çelik M, Meral R, Kanlıada D, Aydemir L, Başaran B, Kıyak E (December 1, 2017) Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?. The Turkish Journal of Ear Nose and Throat 27 6 269–275.
IEEE M. Çelik, R. Meral, D. Kanlıada, L. Aydemir, B. Başaran, and E. Kıyak, “Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?”, Tr-ENT, vol. 27, no. 6, pp. 269–275, 2017.
ISNAD Çelik, Mehmet et al. “Post-Radiotherapy Hypothyroidism in Head and Neck Cancers: When Should We Be Concerned?”. The Turkish Journal of Ear Nose and Throat 27/6 (December 2017), 269-275.
JAMA Çelik M, Meral R, Kanlıada D, Aydemir L, Başaran B, Kıyak E. Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?. Tr-ENT. 2017;27:269–275.
MLA Çelik, Mehmet et al. “Post-Radiotherapy Hypothyroidism in Head and Neck Cancers: When Should We Be Concerned?”. The Turkish Journal of Ear Nose and Throat, vol. 27, no. 6, 2017, pp. 269-75.
Vancouver Çelik M, Meral R, Kanlıada D, Aydemir L, Başaran B, Kıyak E. Post-radiotherapy hypothyroidism in head and neck cancers: When should we be concerned?. Tr-ENT. 2017;27(6):269-75.