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

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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.

Original languageEnglish
Pages (from-to)468-476
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume77
Issue number2
DOIs
Publication statusPublished - 2010 Jun 1

All Science Journal Classification (ASJC) codes

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

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    Diaz, R., Jaboin, J. J., Morales-Paliza, M., Koehler, E., Phillips, J. G., Stinson, S., Gilbert, J., Chung, C. H., Murphy, B. A., Yarbrough, W. G., Murphy, P. B., Shyr, Y., & Cmelak, A. J. (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, 77(2), 468-476. https://doi.org/10.1016/j.ijrobp.2009.05.018