TY - JOUR
T1 - Radiation-Induced Hypothyroidism After Radical Intensity Modulated Radiation Therapy for Oropharyngeal Carcinoma
AU - Kamal, Mona
AU - Peeler, Christopher Ryan
AU - Yepes, Pablo
AU - Mohamed, Abdallah S.R.
AU - Blanchard, Pierre
AU - Frank, Steven
AU - Chen, Lei
AU - Jethanandani, Amit
AU - Kuruvilla, Rohit
AU - Greiner, Benjamin
AU - Harp, Jared
AU - Granberry, Robin
AU - Mehta, Vivek
AU - Rock, Crosby
AU - Hutcheson, Katherine
AU - Cardenas, Carlos
AU - Gunn, G. Brandon
AU - Fuller, Clifton
AU - Mirkovic, Dragan
N1 - Funding Information:
Sources of support: This work is directly supported by the Andrew Sabin Family Foundation; Dr Fuller is a Sabin Family Foundation Fellow. Family of Paul W. Beach is providing direct salary support for Dr Kamal. Amit Jethanandani is supported by the Dunagan MD Medical Education Fund through The University of Tennessee Health Science Center, College of Medicine. Drs Yepes, Peeler, and Mirkovic are supported by Cancer Research Institute of Texas (CPRIT) award RP160232. Disclosures: Drs. Mohamed, Hutcheson, and Fuller received funding support from the National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and NIH/ National Cancer Institute (NCI) Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01). Dr Fuller receives federal grant and salary support from the NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50CA097007-10) and a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NCI QUBBD (1R01CA225190-01); the NIH Big Data to Knowledge (BD2K) Program of the NCI Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NCI Early Phase Clinical Trials in Imaging and Image Guided Interventions Program (1R01CA218148-01); a General Electric Healthcare/MD Anderson Center for Advanced Biomedical Imaging In-Kind Award; an Elekta AB/MD Anderson Department of Radiation Oncology Seed Grant; the Center for Radiation Oncology Research (CROR) at MD Anderson Cancer Center Seed Grant; and the MD Anderson Institutional Research Grant (IRG) Program and the Cancer center Support Grant Radiation Oncology/Cancer Imaging Program Seed Grant (5P30CA016672). Dr Fuller received industry grant support and speaker travel funding from Elekta AB.
Publisher Copyright:
© 2019 The Author(s)
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: To evaluate 2 published normal tissue complication probability models for radiation-induced hypothyroidism (RHT) on a large cohort of oropharyngeal carcinoma (OPC) patients who were treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: OPC patients treated with retrievable IMRT Digital Imaging and Communications in Medicine (DICOMs) data and available baseline and follow-up thyroid function tests were included. Mean dose (Dmean) to the thyroid gland (TG) and its volume were calculated. The study outcome was clinical HT at least 6 months after radiation therapy, which was defined as grade ≥2 HT per Common Terminology Criteria for Adverse Events grading system (symptomatic hypothyroidism that required thyroid replacement therapy). Regression analyses and Wilcoxon rank-sum test were used. Receiver operating characteristic curves and area under the curve for the fitted model were calculated. Results: In the study, 360 OPC patients were included. The median age was 58 years. Most tumors (51%) originated from the base of tongue. IMRT-split field was used in 95%, and median radiation therapy dose was 69.96 Gy. In the study, 233 patients (65%) developed clinical RHT that required thyroid replacement therapy. On multivariate analysis higher Dmean and smaller TG volume maintained the statistically significant association with the risk of clinical RHT (P < .0001). Dmean was significantly higher in patients with clinical RHT versus those without (50 vs 42 Gy, P < .0001). Patients with RHT had smaller TG volume compared with those without (11.8 compared with 12.8 mL, P < .0001). AUC of 0.72 and 0.66 were identified for fitted model versus for the applied Boomsma et al and Cella et al models, respectively. Conclusions: Volume and Dmean of the TG are important predictors of clinical RHT and shall be integrated into normal tissue complication probability models for RHT. Dmean and thyroid volume should be considered during the IMRT plan optimization in OPC patients.
AB - Purpose: To evaluate 2 published normal tissue complication probability models for radiation-induced hypothyroidism (RHT) on a large cohort of oropharyngeal carcinoma (OPC) patients who were treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: OPC patients treated with retrievable IMRT Digital Imaging and Communications in Medicine (DICOMs) data and available baseline and follow-up thyroid function tests were included. Mean dose (Dmean) to the thyroid gland (TG) and its volume were calculated. The study outcome was clinical HT at least 6 months after radiation therapy, which was defined as grade ≥2 HT per Common Terminology Criteria for Adverse Events grading system (symptomatic hypothyroidism that required thyroid replacement therapy). Regression analyses and Wilcoxon rank-sum test were used. Receiver operating characteristic curves and area under the curve for the fitted model were calculated. Results: In the study, 360 OPC patients were included. The median age was 58 years. Most tumors (51%) originated from the base of tongue. IMRT-split field was used in 95%, and median radiation therapy dose was 69.96 Gy. In the study, 233 patients (65%) developed clinical RHT that required thyroid replacement therapy. On multivariate analysis higher Dmean and smaller TG volume maintained the statistically significant association with the risk of clinical RHT (P < .0001). Dmean was significantly higher in patients with clinical RHT versus those without (50 vs 42 Gy, P < .0001). Patients with RHT had smaller TG volume compared with those without (11.8 compared with 12.8 mL, P < .0001). AUC of 0.72 and 0.66 were identified for fitted model versus for the applied Boomsma et al and Cella et al models, respectively. Conclusions: Volume and Dmean of the TG are important predictors of clinical RHT and shall be integrated into normal tissue complication probability models for RHT. Dmean and thyroid volume should be considered during the IMRT plan optimization in OPC patients.
UR - http://www.scopus.com/inward/record.url?scp=85074830188&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074830188&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2019.08.006
DO - 10.1016/j.adro.2019.08.006
M3 - Article
C2 - 32051897
AN - SCOPUS:85074830188
SN - 2452-1094
VL - 5
SP - 111
EP - 119
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 1
ER -