Radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy with or without chemotherapy: Development of a nomogram based on the equivalent dose
Radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy with or without chemotherapy: Development of a nomogram based on the equivalent dose
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接受调强放射治疗（联合或不联合化疗）的鼻咽癌患者中放射诱发的甲状腺功能减退症：根据等效剂量绘制列线图
DOI：
10.1016/j.oraloncology.2021.105378
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发表时间：
2021-06-23
期刊：
影响因子：
4.8
通讯作者：
Zhao, Chong
中科院分区：
文献类型：
--
作者：
Zhu, Man-yi;Wu, Hai-jun;Zhao, Chong
目的：本研究的目的是建立一个诺模图，预测放射性甲状腺功能减退症（RHT）的基础上的等效剂量为2戈伊每部分（EQD 2）的鼻咽癌（NPC）患者接受调强放疗（IMRT）与化疗或不化疗。方法：244例符合条件的鼻咽癌患者入选本研究。患者的临床因素和甲状腺的剂量体积参数分别从病历和调强放射治疗计划系统中检索。将辐照剂量转换为EQD 2用于分析。最小绝对收缩和选择算子（LASSO）回归分析和多元逻辑回归分析，以确定最佳的预测RHT构建诺模图。结果如下：中位随访63.0个月，调强放疗后3个月和1、2、3、4、5年时RHT的累积发生率分别为10.2%、36.2%、47.6%、54.2%、58.8%和69.4%。将性别、年龄、甲状腺体积和甲状腺V35 Gy（3Gy）作为预测RHT的4个独立因素纳入列线图。列线图的ROC曲线下面积为0.747（95%置信区间为0.685 - 0.809）。校准曲线和DCA曲线表明，诺模图与实际观察结果和临床使用情况吻合良好。结论：在这项研究中提出的诺模图提供了一个可靠的估计鼻咽癌患者调强放疗后的RHT风险，似乎有可能成为一个有用的工具，广泛的临床应用。
Objective: The aim of this study was to establish a nomogram for predicting radiation-induced hypothyroidism (RHT) based on an equivalent dose at 2 Gy per fraction (EQD2) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) with or without chemotherapy. Methods: Two hundred forty-four eligible patients with NPC were recruited for this study. Patients' clinical factors and dose-volume parameters of the thyroid gland were retrieved from medical records and the IMRT treatment planning system, respectively. The irradiation doses were converted into EQD2 for analysis. Least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were performed to identify optimal predictors of RHT for constructing the nomogram. Results: With a median follow-up of 63.0 months, the cumulative incidence rates of RHT at 3 months and 1-, 2-, 3, 4- and 5- year after IMRT were 10.2%, 36.2%, 47.6%, 54.2%, 58.8% and 69.4%, respectively. Four independent factors for predicting RHT, including gender, age, pretreatment volume of the thyroid gland and V35Gy(3Gy) of the thyroid gland, were identified and incorporated into the nomogram. The area under the ROC curve of the nomogram was 0.747 (95% confidence interval 0.685 - 0.809). Calibration curves and DCA curves showed that the nomogram was in good agreement with the actual observations and clinical usefulness. Conclusions: The nomogram proposed in this study provides a reliable estimate of RHT risk in patients with NPC after IMRT and appears to have the potential to be a useful tool for widespread clinical applications.