Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review
ABSTRACT To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.
Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review.
The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies.
Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.
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ABSTRACT: Thyroid dysfunction is an important adverse effect of tyrosine kinase inhibitors (TKI). To assess the prevalence of hypothyroidism in patients treated with TKI at our institution between 2003 and 2012, we reviewed their clinical records. One hundred and seven patients were evaluated, 56% male. Erlotinib was used in 27 patients, imatinib in 30, sunitinib in 17, lapatinib in 15, sorafenib in 7, gefitinib in 1 and more than one TKI in 10 patient (8 imatinib+sunitinib, 1 sunitinib+sorafenib, 1 imatinib+dasatinib). Of 107 patients, 59 (55%) performed thyroid function evaluation, in which hypothyroidism was documented in 35.6% (21 patients). Hypothyroidism was detected after a mean (±SD) time of 9.3 ± 5.8 months of therapy. Levothyroxine was initiated in 11 patients. Hypothyroidism occurred in 57%, 46% e 17% of the patients treated with sunitinib, lapatinib and sorafenib, respectively. Seventy five percent of the patients treated with more than one TKI presented hypothyroidism and in all cases one of TKI was sunitinib. Of the patients receiving erlotinib, imatinib or gefitinib monotherapy that underwent thyroid function evaluation, none had hypothyroidism. The main limitation of the study is the low number of patients in each subgroup, however hypothyroidism seems to be more prevalent in patients on sunitinib or lapatinib. With the high prevalence of hypothyroidism in patients under TKI it is recommended to perform thyroid function assessment before and periodically during the treatment.07/2013; 8(2). DOI:10.1016/j.rpedm.2013.06.003
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ABSTRACT: Objective: Chemotherapy-related toxicities are difficult to predict before treatment. In this study, we investigated whether thyroid hormone receptor beta (THRB) genetic polymorphisms can serve as a potential biomarker in patients with esophageal squamous cell carcinoma (ESCC).Methods: Forty-nine Japanese patients with ESCC who received a definitive chemoradiotherapy (CRT) with 5-fluorouracil and cisplatin in conjunction with concurrent irradiation were retrospectively analyzed. Severe acute toxicities, including leukopenia, stomatitis, and cheilitis, were evaluated according to 6 single nucleotide polymorphisms (SNPs) in the gene; the intronic SNPs of rs7635707 G/T, rs6787255 A/C, rs9812034 G/T, and rs9310738 C/T and the SNPs in the 3'-untranslated region (3'-UTR) of rs844107 C/T and rs1349265 G/A.Results: Distribution of the 4 intronic SNPs, but not the 2 SNPs in the 3'-UTR, showed a significant difference between patients with and without severe acute leukopenia. Stomatitis and cheilitis were not associated with any of the 6 analyzed SNPs. Frequency of haplotype of the 4 intronic SNPs reached approximately 97% with the 2 major haplotypes G-A-G-C (73.4%) and T-C-T-T (23.5%).Conclusions: THRB intronic SNPs can provide useful information on CRT-related severe myelotoxicity in patients with ESCC. Future studies will be needed to confirm these findings.International journal of medical sciences 10/2012; 9(9):748-56. DOI:10.7150/ijms.5081 · 1.55 Impact Factor
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ABSTRACT: The purpose of this study is to evaluate the possible predictors of thyroid disorders after neck radiotherapy, with a focus on radiation dose-volume factors.Radiation Oncology 05/2014; 9. DOI:10.1186/1748-717X-9-104 · 2.36 Impact Factor