Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: A systematic review. (March 2022)

• Record Type: Journal Article
• Authors: Chow, James C.H.; Cheung, Ka-Man; Cheung, Gavin T.C.; Tam, Anthony H.P.; Lui, Jeffrey C.F.; Lee, Francis K.H.; Au, Kwok-Hung; Ng, Wai-Tong; Lee, Anne W.M.; Yiu, Harry H.Y.
• Is Part Of: Clinical and translational radiation oncology. Volume 33(2022)
• Page Start: 83
• Page End: 92
• Publication Date: 2022-03
• Subjects: 3DRT dimensional radiotherapy -- CI confidence interval -- CT computer tomography -- Dmean mean dose -- Dmin minimum dose -- HNC head and neck cancer -- IMRT intensity modulated radiotherapy -- NPC nasopharyngeal cancer -- NTCP normal tissue complication probability -- OPC oropharyngeal cancer -- OR odds ratio -- ROC receiver operating curve -- TSH thyroid stimulating hormone -- PRIMSA Preferred Reporting Items for Systematic Reviews and meta-Analyses -- QUANTEC Quantitative Analysis of The Normal Tissue Effects in the Clinic -- ULN upper limit of normal -- Vx thyroid volume that receives x Gy of radiation dose -- VSx thyroid volume that is spared from x Gy of radiation dose; Head and neck neoplasms -- Radiotherapy -- Hypothyroidism -- Survivorship; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2022.01.001
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: This systematic review included 29 studies (n = 4, 530 patients) on dosimetric predictors of primary hypothyroidism in HNC. Average crude incidence of primary hypothyroidism after HNC radiotherapy was 41.4%. Thyroid Dmean and V50 were the most widely reported dosimetric predictors for hypothyroidism. Thyroid volume is a predictor of hypothyroidism (pooled aOR 0.89 per 1 cc increment) independent of radiation dosimetry. Thyroid gland constraints individualized for thyroid volume are crucial in HNC radiotherapy. Abstract: 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 dose-volume 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.