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Open AccessArticle

Radiation-Induced Hypothyroidism in Patients with Oropharyngeal Cancer Treated with IMRT: Independent and External Validation of Five Normal Tissue Complication Probability Models

1
Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland
2
Department of Radiotherapy, Medical University of Lodz, 95-513 Lodz, Poland
3
N. Copernicus Memorial Regional Specialist Hospital, Department of Radiotherapy, 95-513 Lodz, Poland
4
Department of Radiation Oncology, Oncology Center of Radom, 26-600 Radom, Poland
5
Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO)—branch in Gliwice, 44-101 Gliwice, Poland
6
I Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO)—branch in Gliwice, 44-101 Gliwice, Poland
7
Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 91-738 Lodz, Poland
8
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
9
Department of Radiotherapy, Military Institute of Medicine, 04-349 Warsaw, Poland
10
Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2020, 12(9), 2716; https://doi.org/10.3390/cancers12092716
Received: 21 August 2020 / Revised: 12 September 2020 / Accepted: 19 September 2020 / Published: 22 September 2020
(This article belongs to the Special Issue Symptoms and Side Effects in Cancer Survivors)
Hypothyroidism is a common complication of therapeutic irradiation in the neck area. Several dose-response models have been proposed to predict its’ occurrence based on clinical and radiomic features. We aimed to externally validate the results of five such models in a prospectively recruited cohort of 108 patients with oropharyngeal cancer. Two of the evaluated models, published by Rønjom et al. and by Boomsma et al., had satisfactory performance. Both models are based on mean thyroid dose and thyroid volume. Three remaining models, by Cella et al., Bakhshandeh et al. and Vogelius et al., performed significantly worse. Short-term change in the level of thyroid-stimulating hormone (TSH) after radiation therapy was not indicative of hypothyroidism development in long term. We conclude that the models by Rønjom et al. and by Boomsma et al. are feasible for long-term prediction of hypothyroidism in oropharyngeal cancer survivors treated with intensity-modulated radiation therapy.
We aimed to externally validate five normal tissue complication probability (NTCP) models for radiation-induced hypothyroidism (RIHT) in a prospectively recruited cohort of 108 patients with oropharyngeal cancer (OPC). NTCP scores were calculated using original published formulas. Plasma thyrotropin (TSH) level was additionally assessed in the short-term after RT. After a median of 28 months of follow-up, thirty one (28.7%) patients developed RIHT. Thyroid mean dose and thyroid volume were significant predictors of RIHT: odds ratio equal to 1.11 (95% CI 1.03–1.19) for mean thyroid dose and 0.87 (95%CI 0.81–0.93) for thyroid volume in univariate analyses. Two of the evaluated NTCP models, published by Rønjom et al. and by Boomsma et al., had satisfactory performance with accuracies of 0.87 (95%CI 0.79–0.93) and 0.84 (95%CI: 0.76–0.91), respectively. Three remaining models, by Cella et al., Bakhshandeh et al. and Vogelius et al., performed significantly worse, overestimating the risk of RIHT in this patient cohort. A short-term TSH level change relative to baseline was not indicative of RIHT development in the follow-up (OR 0.96, 95%CI: 0.65–1.42, p = 0.825). In conclusion, the models by Rønjom et al. and by Boomsma et al. demonstrated external validity and feasibility for long-term prediction of RIHT in survivors of OPC treated with Intensity-Modulated Radiation Therapy (IMRT). View Full-Text
Keywords: hypothyroidism; patient reported outcome measures; probability; radiation injuries; dose–response relationship; radiation; head and neck neoplasms; oropharyngeal cancer; NTCP hypothyroidism; patient reported outcome measures; probability; radiation injuries; dose–response relationship; radiation; head and neck neoplasms; oropharyngeal cancer; NTCP
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Nowicka, Z.; Tomasik, B.; Papis-Ubych, A.; Bibik, R.; Graczyk, Ł.; Latusek, T.; Rutkowski, T.; Wyka, K.; Fijuth, J.; Schoenfeld, J.D.; Chałubińska-Fendler, J.; Fendler, W. Radiation-Induced Hypothyroidism in Patients with Oropharyngeal Cancer Treated with IMRT: Independent and External Validation of Five Normal Tissue Complication Probability Models. Cancers 2020, 12, 2716.

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