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Hypothyroidism as a consequence of intensity-modulated radiation therapy (IMRT) with concurrent taxane-based chemotherapy for locally-advanced head and neck cancer (LAHNC)



Hypothyroidism as a consequence of intensity-modulated radiation therapy (IMRT) with concurrent taxane-based chemotherapy for locally-advanced head and neck cancer (LAHNC)



Journal of Clinical Oncology 26(15_Suppl): 6048-6048



NlmCategory="UNASSIGNED">6048 Background: We conducted a retrospective review of 129 consecutively-treated locally advanced head and neck cancer (LAHNC) patients treated with intensity modulated radiotherapy (IMRT)/chemotherapy to determine the rate and potential risk factors for developing hypothyroidism post-treatment. In order to simplify IMRT planning, a single dose-painting IMRT plan was used: 69.3 Gy (2.1 Gy x 33 fractions) to gross disease and 56.1 Gy (1.7 Gy x 33 fractions) simultaneously to clinically normal nodes down to the clavicles. Fifty percent of the volume of the larynx/trachea/esophagus was limited to ≤25 Gy. Dose-volume histograms (DVHs) were used to determine radiation dose to thyroid, and to correlate dose with parameters predicting the development of hypothyroidism. Comparison to DVHs using 3-D RT using a 2cm wide midline block on the lower neck field was done in the same patients. Weekly paclitaxel 30mg/m2 and carboplatin AUC 1 were given concurrently with IMRT. Patients included male-86%, female-14%; median age was 56.8 years (37-89). Primary site included hypopharynx-4%, larynx-23%, nasopharynx-9%, oral cavity-3%, oropharynx-58%, sinus-2%, unknown primary-2%. Median follow-up was 1.9 years. IMRT doses to thyroid gland had a significantly higher minimum dose (2365 cGy) and volume receiving 20 Gy (V20) (99%), as compared to 3D RT (525 cGy, 89%) (p=0.001, p=0.0003). There was no difference in median dose by IMRT (5026 cGy) than with 3D RT (4775 cGy) (p=0.31). To date, 45 patients (35%) have developed hypothyroidism after median of 1.05 years from IMRT (range 3.9 months to 3.7 years). Comparison to 3D RT (70 Gy) used on ECOG 2399 (with lower neck midline block) in similar patients and with similar chemotherapy shows 4/111 patients (3.6%) developed hypothyroidism at median 3.7 years after treatment (range 1.9-5.2 years) (p<0.001). IMRT for LAHNC results in higher radiation to the thyroid than with conventional 3D RT. Consequently, markedly higher post-treatment hypothyroidism is observed. Furthermore, latency to hypothyroidism onset is shorter with IMRT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are recommended. No significant financial relationships to disclose.

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Accession: 058028024

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PMID: 27950592


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