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Radiother Oncol. 2013 Nov;109(2):317-22. doi: 10.1016/j.radonc.2013.06.029. Epub 2013 Jul 25.

Hypothyroidism after primary radiotherapy for head and neck squamous cell carcinoma: normal tissue complication probability modeling with latent time correction.

Author information

1
Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: Marianne.roenjom@rsyd.dk.

Abstract

BACKGROUND AND PURPOSE:

To develop a normal tissue complication probability (NTCP) model of radiation-induced biochemical hypothyroidism (HT) after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) with adjustment for latency and clinical risk factors.

PATIENTS AND METHODS:

Patients with HNSCC receiving definitive radiotherapy with 66-68Gy without surgery were followed up with serial post-treatment thyrotropin (TSH) assessment. HT was defined as TSH >4.0mU/l. Data were analyzed with both a logistic and a mixture model (correcting for latency) to determine risk factors for HT and develop an NTCP model based on mean thyroid dose (MTD) and thyroid volume.

RESULTS:

203 patients were included. Median follow-up: 25.1months. Five-year estimated risk of HT was 25.6%. In the mixture model, the only independent risk factors for HT were thyroid volume (cm(3)) (OR=0.75 [95% CI: 0.64-0.85], p<0.001) and MTD (Gy) (OR=1.12 [95% CI: 1.07-1.20], p<0.001). From the mixture NTCP-model individual dose constraints for a 25% risk of HT were 26, 38, 48 and 61Gy for thyroid volumes of 10, 15, 20 and 25cm(3), respectively.

CONCLUSIONS:

Comparing the logistic and mixture models demonstrates the importance of latent-time correction in NTCP-modeling. Thyroid dose constraints in treatment planning should be individualized based on thyroid volume.

KEYWORDS:

Head-and-neck cancer; Hypothyroidism; Mixture model; Normal tissue complication probability; Radiotherapy; Thyroid gland constraint

PMID:
23891099
DOI:
10.1016/j.radonc.2013.06.029
[Indexed for MEDLINE]

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