| 王冬青,翟利民,高敏,等.头颈部肿瘤调强放射治疗后甲状腺功能减退的临床参数和剂量影响因素[J].中华放射医学与防护杂志,2014,34(3):201-205.Wang Dongqing,Zhai Limin,Gao Min,et al.Clinical and dosimetric factors for radiation-induced hypothyroidism following intensity-modulated radiotherapy in patients with head-and-neck cancer[J].Chin J Radiol Med Prot,2014,34(3):201-205 |
| 头颈部肿瘤调强放射治疗后甲状腺功能减退的临床参数和剂量影响因素 |
| Clinical and dosimetric factors for radiation-induced hypothyroidism following intensity-modulated radiotherapy in patients with head-and-neck cancer |
| 投稿时间：2013-06-19 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.03.011 |
| 中文关键词: 头颈部肿瘤 调强放射治疗 甲状腺功能减退 |
| 英文关键词:Head-and-neck cancer Intensity-modulated radiotherapy Hypothyroidism |
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| 中文摘要: |
| 目的 探讨头颈部肿瘤患者接受调强放射治疗（IMRT）后出现甲状腺功能减退（HT）与患者临床特征参数、剂量体积直方图（DVH）参数的相关性。方法 收集28例接受头颈部IMRT（颈部照射剂量 ≥ 40 Gy）联合化疗的肿瘤患者资料。治疗前后及随访观察中监测血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。原发性HT定义为血清TSH高于正常值的上限伴或不伴有FT3/FT4的降低。基于放疗计划系统DVH，记录每一位患者甲状腺体积（TV）、甲状腺平均照射剂量（MTD）、最大点剂量（Dmax）、甲状腺接受≥5~50 Gy的相对体积（表示为Vx，x=5~50，5 Gy为间隔）。回顾性分析患者年龄、性别、化疗、TV、MTD、Dmax及各DVH参数与HT的相关性。 结果 全组患者治疗前血清TSH、FT3和FT4中位数分别为1.51 μU/ml、5.38和18.57 pmol/L。中位随访15个月（3~57月），14例（50.0%）患者出现HT，出现HT的中位时间为放疗后8个月（2~23月）。患者首次监测发现HT时间点的TSH、FT3和FT4中位数分别为7.48 μU/ml（4.67~60.11 μU/ml）、4.05 pmol/L（0.40~5.77 pmol/L）和12.32 pmol/L（4.12~21.25 pmol/L），HT患者的TSH较治疗前明显升高（P<0.01）。HT患者的TV中位数为17.76 cm3，显著低于未出现HT患者的20.21 cm3（Z=-2.154，P<0.05）。单因素分析显示患者年龄和V40与HT的发生风险相关（χ2=11.340、4.102，OR=30.0、9.17，P<0.05）。多因素分析证实患者年龄、V40均是HT的独立影响因素（OR=34.7、6.13，P<0.05）。结论 头颈部肿瘤患者IMRT后出现HT伴随TSH的显著增高。低龄、甲状腺体积较小的患者，甲状腺V40大于80%是发生HT的高风险因素。 |
| 英文摘要: |
| Objective To determine the clinical and dosimetric factors associated with radiation-induced hypothyroidism (HT) in head-and-neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods The clinical data of 28 head-and-neck cancer patients undergoing IMRT (with the prescribed radiation dose of neck ≥ 40 Gy) plus chemotherapy were retrospectively recruited. The serum levels of thyroid-stimulating hormone (TSH), free triiodo-thyronine (FT3), and free thyroxine (FT4) of each patient were recorded basally and at different times after the end of therapy. Primary HT was defined as increased TSH with or without decreased FT3 and/or FT4. Based on each patient's dose-volume histogram (DVH), the volume percentages of thyroid absorbing 5-50 Gy at interval of 5 Gy were estimated (marked as Vx, x=5-50) together with the mean thyroid dose (MTD), maximum dose (Dmax) and thyroid volume (TV). To evaluate the clinical and dosimetric factors associated with HT, univariate and multivariate logistic regression analysis were performed. Results The median serum levels of TSH, FT3, and FT4 before treatment were 1.51 μU/ml, 5.38 pmol/L, and 18.57 pmol/L, respectively. During the follow-up time of of 15 months (3-57 months), 14 patients (50.0%) developed HT, and the median time for firstly detected HT was 8 months (2-23 months) after treatment. The median serum levels of TSH, FT3, and FT4 when HT was firstly detected were 7.48 μU/ml (4.67-60.11 μU/ml), 4.05 pmol/L (0.40-5.77 pmol/L), and 12.32 pmol/L (4.12-21.25 pmol/L) respectively. There was a significant increasing in TSH level in patients with HT during the follow-up (P<0.05). The TV of the patients with HT was significantly lower than those without HT (Z=-2.154, P<0.05). Univariate analysis showed that younger age and V40 ≥ 80% were associated with a higher risk of HT (χ2=11.340, 4.102; OR=30.0, 9.17; P<0.05). Multivariate analysis confirmed that age and V40 were the independent predictors (OR=34.7, 6.13; P<0.05). Conclusions HT after IMRT for head-and-neck cancer is accompanied by elevated TSH levels. Younger age, smaller thyroid volume, and V40 ≥ 80% have been identified as risk factors for HT after IMRT. |
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