HYPOTHYROIDISM AS A CONSEQUENCE OF INTENSITY-MODULATED RADIOTHERAPY WITH CONCURRENT TAXANE-BASED CHEMOTHERAPY FOR LOCALLY ADVANCED HEAD-AND-NECK CANCER
HYPOTHYROIDISM AS A CONSEQUENCE OF INTENSITY-MODULATED RADIOTHERAPY WITH CONCURRENT TAXANE-BASED CHEMOTHERAPY FOR LOCALLY ADVANCED HEAD-AND-NECK CANCER
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DOI：
10.1016/j.ijrobp.2009.05.018
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发表时间：
2010-06-01
影响因子：
7
通讯作者：
Cmelak, Anthony J.
中科院分区：
文献类型：
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作者：
Diaz, Roberto;Jaboin, Jerry J.;Cmelak, Anthony J.
目的：对168例连续接受调强放疗/化疗的局部晚期头颈癌（LAHNC）患者进行回顾性分析，探讨甲状腺功能减退的发生率及危险因素。方法与材料：调强放疗分33次/天，对肉眼病变放疗剂量为69.3 Gy，对临床正常宫颈淋巴结放疗剂量为56.1 Gy。使用IMRT计划的剂量体积直方图（DVHs）来确定甲状腺的辐射剂量，并将随机选择重新计划的10例患者的剂量体积直方图（DVHs）与常规三维放疗（3D-RT）的DVHs进行比较，并与在IMRT期间故意避免甲状腺的16例患者的DVHs进行比较。每周紫杉醇（30 mg/m(2)）和曲线下卡铂面积与IMRT同时给予。结果：128例可评估患者中有61例（47.7%）在IMRT后中位1.08年（2.4个月至3.9年）发生甲状腺功能减退。年龄和照射甲状腺的体积与IMRT后甲状腺功能减退的发生有关。与3D-RT相比，没有甲状腺剂量限制的IMRT导致的最小、最大和中位剂量明显更高(p
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/m(2)) 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