Hypothyroidism after craniospinal irradiation with proton or photon therapy in patients with medulloblastoma
Hypothyroidism after craniospinal irradiation with proton or photon therapy in patients with medulloblastoma
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DOI：
10.1080/08880018.2018.1471111
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发表时间：
2018-01-01
影响因子：
1.7
通讯作者：
Chintagumpala, Murali
中科院分区：
文献类型：
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作者：
Bielamowicz, Kevin;Okcu, M. Fatih;Chintagumpala, Murali
背景：颅脊髓照射（CSI）由于照射下丘脑-垂体轴（HPA）或甲状腺，经常导致髓母细胞瘤儿童内分泌缺陷。质子放射治疗 (PRT) 的 CSI 有可能通过减少对这些器官的辐射剂量来降低甲状腺功能减退症的风险。本研究比较了接受光子放射治疗 (XRT) 或 PRT 治疗的髓母细胞瘤患者发生甲状腺功能减退的风险。方法：对 1997 年至 2014 年间在单一机构诊断的接受 CSI 的髓母细胞瘤患者的记录进行回顾性分析。纳入了 95 名进行过基线和年度随访甲状腺研究的患者（54 名 XRT 和 41 名 PRT）。我们使用区间删失 Cox 回归来计算发生任何原发性和中枢性甲状腺功能减退症的风险比。结果：PRT 中放射后距上次甲状腺研究的中位时间为 3.8 年，XRT 中为 9.6 年，33/95 (34.7%) 患者出现甲状腺功能减退症（甲状腺功能减退症中位时间：2.6 年）。接受 XRT 的患者中有 25/54 (46.3%) 出现甲状腺功能减退症，而 PRT 组则有 8/41 (19%) 出现甲状腺功能减退症 (HR =1.85，p=.14)。 15/95 (15.8%) 患者出现原发性甲状腺功能减退症：XRT 后为 12/54 (22.2%)，PRT 后为 3/41 (7.3%)（HR =2.1，p=.27）。 17/95 (18.0%) 患者出现中枢性甲状腺功能减退症：XRT 后为 13/54 (24.0%)，PRT 后为 4/41 (9.8%)（HR =2.16，p=.18）。结论：髓母细胞瘤患者使用 PRT 与甲状腺功能减退风险的数字降低相关，但并非显着降低。必须进行进一步的研究，包括更大的数量和更长的随访时间，以评估 PRT 实现的较低辐射剂量是否显示出统计学上的显着差异。
Background: Craniospinal irradiation (CSI) often results in endocrine deficiencies in children with medulloblastoma due to irradiation of the hypothalamic-pituitary axis (HPA) or the thyroid gland. CSI with Proton radiation therapy (PRT) has the potential to decrease the risk of hypothyroidism by reduction in radiation dose to these organs. This study compares the risk for hypothyroidism in patients with medulloblastoma treated with Photon radiation therapy (XRT) or PRT. Methods: The records of patients with medulloblastoma diagnosed at a single institution between 1997 and 2014 who received CSI were, retrospectively, reviewed. Ninety-five patients (54 XRT and 41 PRT) who had baseline and yearly follow-up thyroid studies were included. We used interval censored Cox regression to calculate hazard ratios of developing any, primary, and central hypothyroidism. Results: With a median time to last thyroid studies post radiation of 3.8 years in PRT and 9.6 years in XRT, 33/95 (34.7%) patients developed hypothyroidism (median time to hypothyroidism: 2.6 years). Hypothyroidism developed in 25/54 (46.3%) who received XRT vs. 8/41 (19%) in the PRT group (HR =1.85, p=.14). Primary hypothyroidism developed in 15/95 (15.8%) patients: 12/54 (22.2%) after XRT and 3/41 (7.3%) after PRT (HR =2.1, p=.27). Central hypothyroidism developed in 17/95 (18.0%) patients: 13/54 (24.0%) after XRT and 4/41 (9.8%) after PRT (HR =2.16, p=.18). Conclusions: The use of PRT in patients with medulloblastoma was associated with numerically lower but not significantly lower risk of hypothyroidism. Further studies including larger numbers and longer follow up must be performed to assess whether lower radiation doses achieved with PRT show statistically significant differences.