Hypothyroidism as a Consequence of Intensity-Modulated Radiotherapy With Concurrent Taxane-Based Chemotherapy for Locally Advanced Head-and-Neck Cancer

Roberto Diaz, Jerry J. Jaboin, Manuel Morales-Paliza, Elizabeth Koehler, John G. Phillips, Scott Stinson, Jill Gilbert, Christine H. Chung, Barbara A. Murphy, Wendell G. Yarbrough, Patrick B. Murphy, Yu Shyr, Anthony J. Cmelak

Research output: Contribution to journalArticle

Abstract

Purpose: To conduct a retrospective review of 168 consecutively treated locally advanced head-and-neck cancer (LAHNC) patients treated with intensity-modulated radiotherapy (IMRT)/chemotherapy, to determine the rate and risk factors for developing hypothyroidism. Methods and Materials: Intensity-modulated radiotherapy was delivered in 33 daily fractions to 69.3 Gy to gross disease and 56.1 Gy to clinically normal cervical nodes. Dose-volume histograms (DVHs) of IMRT plans were used to determine radiation dose to thyroid and were compared with DVHs using conventional three-dimensional radiotherapy (3D-RT) in 10 of these same patients randomly selected for replanning and with DVHs of 16 patients in whom the thyroid was intentionally avoided during IMRT. Weekly paclitaxel (30 mg/m2) and carboplatin area under the curve-1 were given concurrently with IMRT. Results: Sixty-one of 128 evaluable patients (47.7%) developed hypothyroidism after a median of 1.08 years after IMRT (range, 2.4 months to 3.9 years). Age and volume of irradiated thyroid were associated with hypothyroidism development after IMRT. Compared with 3D-RT, IMRT with no thyroid dose constraints resulted in significantly higher minimum, maximum, and median dose (p <0.0001) and percentage thyroid volume receiving 10, 20, and 60 Gy (p <0.05). Compared with 3D-RT, IMRT with thyroid dose constraints resulted in lower median dose and percentage thyroid volume receiving 30, 40, and 50 Gy (p <0.005) but higher minimum and maximum dose (p <0.005). Conclusions: If not protected, IMRT for LAHNC can result in higher radiation to the thyroid than with conventional 3D-RT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are achievable and recommended.

Original languageEnglish (US)
Pages (from-to)468-476
Number of pages9
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume77
Issue number2
DOIs
StatePublished - Jun 1 2010
Externally publishedYes

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Intensity-Modulated Radiotherapy
chemotherapy
Head and Neck Neoplasms
Hypothyroidism
radiation therapy
cancer
Thyroid Gland
Drug Therapy
dosage
histograms
Radiation
taxane
radiation
Carboplatin
Paclitaxel
Area Under Curve
Radiotherapy

Keywords

  • Concurrent chemoradiation
  • Head-and-neck cancer
  • Hypothyroidism
  • IMRT
  • Radiation side effects

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Hypothyroidism as a Consequence of Intensity-Modulated Radiotherapy With Concurrent Taxane-Based Chemotherapy for Locally Advanced Head-and-Neck Cancer. / Diaz, Roberto; Jaboin, Jerry J.; Morales-Paliza, Manuel; Koehler, Elizabeth; Phillips, John G.; Stinson, Scott; Gilbert, Jill; Chung, Christine H.; Murphy, Barbara A.; Yarbrough, Wendell G.; Murphy, Patrick B.; Shyr, Yu; Cmelak, Anthony J.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 77, No. 2, 01.06.2010, p. 468-476.

Research output: Contribution to journalArticle

Diaz, R, Jaboin, JJ, Morales-Paliza, M, Koehler, E, Phillips, JG, Stinson, S, Gilbert, J, Chung, CH, Murphy, BA, Yarbrough, WG, Murphy, PB, Shyr, Y & Cmelak, AJ 2010, 'Hypothyroidism as a Consequence of Intensity-Modulated Radiotherapy With Concurrent Taxane-Based Chemotherapy for Locally Advanced Head-and-Neck Cancer', International Journal of Radiation Oncology, Biology, Physics, vol. 77, no. 2, pp. 468-476. https://doi.org/10.1016/j.ijrobp.2009.05.018
Diaz, Roberto ; Jaboin, Jerry J. ; Morales-Paliza, Manuel ; Koehler, Elizabeth ; Phillips, John G. ; Stinson, Scott ; Gilbert, Jill ; Chung, Christine H. ; Murphy, Barbara A. ; Yarbrough, Wendell G. ; Murphy, Patrick B. ; Shyr, Yu ; Cmelak, Anthony J. / Hypothyroidism as a Consequence of Intensity-Modulated Radiotherapy With Concurrent Taxane-Based Chemotherapy for Locally Advanced Head-and-Neck Cancer. In: International Journal of Radiation Oncology, Biology, Physics. 2010 ; Vol. 77, No. 2. pp. 468-476.
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abstract = "Purpose: To conduct a retrospective review of 168 consecutively treated locally advanced head-and-neck cancer (LAHNC) patients treated with intensity-modulated radiotherapy (IMRT)/chemotherapy, to determine the rate and risk factors for developing hypothyroidism. Methods and Materials: Intensity-modulated radiotherapy was delivered in 33 daily fractions to 69.3 Gy to gross disease and 56.1 Gy to clinically normal cervical nodes. Dose-volume histograms (DVHs) of IMRT plans were used to determine radiation dose to thyroid and were compared with DVHs using conventional three-dimensional radiotherapy (3D-RT) in 10 of these same patients randomly selected for replanning and with DVHs of 16 patients in whom the thyroid was intentionally avoided during IMRT. Weekly paclitaxel (30 mg/m2) and carboplatin area under the curve-1 were given concurrently with IMRT. Results: Sixty-one of 128 evaluable patients (47.7{\%}) developed hypothyroidism after a median of 1.08 years after IMRT (range, 2.4 months to 3.9 years). Age and volume of irradiated thyroid were associated with hypothyroidism development after IMRT. Compared with 3D-RT, IMRT with no thyroid dose constraints resulted in significantly higher minimum, maximum, and median dose (p <0.0001) and percentage thyroid volume receiving 10, 20, and 60 Gy (p <0.05). Compared with 3D-RT, IMRT with thyroid dose constraints resulted in lower median dose and percentage thyroid volume receiving 30, 40, and 50 Gy (p <0.005) but higher minimum and maximum dose (p <0.005). Conclusions: If not protected, IMRT for LAHNC can result in higher radiation to the thyroid than with conventional 3D-RT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are achievable and recommended.",
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AU - Diaz, Roberto

AU - Jaboin, Jerry J.

AU - Morales-Paliza, Manuel

AU - Koehler, Elizabeth

AU - Phillips, John G.

AU - Stinson, Scott

AU - Gilbert, Jill

AU - Chung, Christine H.

AU - Murphy, Barbara A.

AU - Yarbrough, Wendell G.

AU - Murphy, Patrick B.

AU - Shyr, Yu

AU - Cmelak, Anthony J.

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N2 - Purpose: To conduct a retrospective review of 168 consecutively treated locally advanced head-and-neck cancer (LAHNC) patients treated with intensity-modulated radiotherapy (IMRT)/chemotherapy, to determine the rate and risk factors for developing hypothyroidism. Methods and Materials: Intensity-modulated radiotherapy was delivered in 33 daily fractions to 69.3 Gy to gross disease and 56.1 Gy to clinically normal cervical nodes. Dose-volume histograms (DVHs) of IMRT plans were used to determine radiation dose to thyroid and were compared with DVHs using conventional three-dimensional radiotherapy (3D-RT) in 10 of these same patients randomly selected for replanning and with DVHs of 16 patients in whom the thyroid was intentionally avoided during IMRT. Weekly paclitaxel (30 mg/m2) and carboplatin area under the curve-1 were given concurrently with IMRT. Results: Sixty-one of 128 evaluable patients (47.7%) developed hypothyroidism after a median of 1.08 years after IMRT (range, 2.4 months to 3.9 years). Age and volume of irradiated thyroid were associated with hypothyroidism development after IMRT. Compared with 3D-RT, IMRT with no thyroid dose constraints resulted in significantly higher minimum, maximum, and median dose (p <0.0001) and percentage thyroid volume receiving 10, 20, and 60 Gy (p <0.05). Compared with 3D-RT, IMRT with thyroid dose constraints resulted in lower median dose and percentage thyroid volume receiving 30, 40, and 50 Gy (p <0.005) but higher minimum and maximum dose (p <0.005). Conclusions: If not protected, IMRT for LAHNC can result in higher radiation to the thyroid than with conventional 3D-RT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are achievable and recommended.

AB - Purpose: To conduct a retrospective review of 168 consecutively treated locally advanced head-and-neck cancer (LAHNC) patients treated with intensity-modulated radiotherapy (IMRT)/chemotherapy, to determine the rate and risk factors for developing hypothyroidism. Methods and Materials: Intensity-modulated radiotherapy was delivered in 33 daily fractions to 69.3 Gy to gross disease and 56.1 Gy to clinically normal cervical nodes. Dose-volume histograms (DVHs) of IMRT plans were used to determine radiation dose to thyroid and were compared with DVHs using conventional three-dimensional radiotherapy (3D-RT) in 10 of these same patients randomly selected for replanning and with DVHs of 16 patients in whom the thyroid was intentionally avoided during IMRT. Weekly paclitaxel (30 mg/m2) and carboplatin area under the curve-1 were given concurrently with IMRT. Results: Sixty-one of 128 evaluable patients (47.7%) developed hypothyroidism after a median of 1.08 years after IMRT (range, 2.4 months to 3.9 years). Age and volume of irradiated thyroid were associated with hypothyroidism development after IMRT. Compared with 3D-RT, IMRT with no thyroid dose constraints resulted in significantly higher minimum, maximum, and median dose (p <0.0001) and percentage thyroid volume receiving 10, 20, and 60 Gy (p <0.05). Compared with 3D-RT, IMRT with thyroid dose constraints resulted in lower median dose and percentage thyroid volume receiving 30, 40, and 50 Gy (p <0.005) but higher minimum and maximum dose (p <0.005). Conclusions: If not protected, IMRT for LAHNC can result in higher radiation to the thyroid than with conventional 3D-RT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are achievable and recommended.

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KW - Head-and-neck cancer

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KW - IMRT

KW - Radiation side effects

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