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Cited by 14Advanced Radiotherapy TechniquesHead and Neck Cancer StudiesEffects of Radiation Exposure

Post-radiation primary hypothyroidism in patients with head and neck cancer: external validation of thyroid gland dose-volume constraints with long-term endocrine outcomes.

Chow, James C.H., Lui, Jeffrey C.F., Cheung, Ka-Man, Tam, Anthony H.P., Lam, Martin H.C., Yuen, Tony Y.S., Lee, Francis K.H., Leung, Alex K.C. +5 more·2022·Radiotherapy and Oncology
DOI 10.1016/j.radonc.2022.10.034
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Abstract

Background Post-radiation primary hypothyroidism is a common late complication in head and neck cancer (HNC) survivors. No radiation dose-volume constraint of the thyroid gland has been externally validated for predicting long-term thyroid function outcomes.Materials and methods This external validation study evaluated the diagnostic properties of 22 radiation dose-volume constraints of the thyroid gland proposed in the literature. Radiation dosimetric data from 488 HNC patients who underwent neck irradiation from January 2013 to December 2015 at two tertiary oncology centers were reviewed. The diagnostic metrics of candidate constraints were computed by inverse probability of censoring weighting and compared using time-dependent receiver operating characteristic (ROC) curves with death designated as a competing event. Multivariable regression analyses were performed using the Fine-Gray sub-distribution hazard model.Results Over a median follow-up period of 6.8 years, 205 (42.0 %) patients developed post-radiation primary hypothyroidism. The thyroid volume spared from 60 Gy (VS60) had the largest area under ROC curve of 0.698 at 5 years after radiotherapy. Of all evaluated constraints, VS60 at a cutoff value of 10 cc had the highest F-score of 0.53. The 5-year hypothyroidism risks of patients with thyroid VS60 ≥ 10 cc and < 10 cc were 14.7 % and 38.2 %, respectively (p < 0.001). The adjusted sub-hazard ratio for post-radiation primary hypothyroidism for VS60 < 10 cc was 1.87 (95 % confidence interval, 1.22-2.87; p < 0.001).Conclusion Thyroid VS60 is the best radiation dose-volume parameter to predict the long-term risk of primary hypothyroidism in patients with HNC who underwent neck irradiation. VS60 ≥ 10 cc is a robust constraint that limits the 5-year primary hypothyroidism risk to less than 15 % and should be routinely employed during radiotherapy optimization.

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  • Up to 42% of patients develop hypothyroidism over a span of 7 years after radiation therapy for head and neck cancer.

    “Approximately 25% to 34% of patients require treatment with levothyroxine after hemithyroidectomy, and up to 42% develophypothyroidismoveraspanof7yearsafterradiationtherapy for head and neck cancer. 26,27”

    From Hypothyroidism: A Review (2025) · cites this paper as [26]

  • Approximately 25% to 34% of patients require treatment with levothyroxine after hemithyroidectomy.

    “Approximately 25% to 34% of patients require treatment with levothyroxine after hemithyroidectomy, and up to 42% develophypothyroidismoveraspanof7yearsafterradiationtherapy for head and neck cancer. 26,27”

    From Hypothyroidism: A Review (2025) · cites this paper as [26]

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Authors
Chow, J. C. H., Lui, J. C. F., Cheung, K.-M., Tam, A. H. P., Lam, M. H. C., Yuen, T. Y. S., Lee, F. K. H., Leung, A. K. C., Au, K.-H., Ng, W.-T., Lee, A. W. M., Kwan, C.-K., & Yiu, H. H. Y.
Affiliations
  • Queen Elizabeth Hospital (CN)
  • United Christian Hospital (CN)
  • Hong Kong Sanatorium and Hospital (HK)
  • University of Hong Kong - Shenzhen Hospital (CN)
Corresponding author
Chow, James C.H.
ORCID
Venue
Radiotherapy and Oncology
Publisher
Elsevier BV
Published
2022-12
Volume
177
Pages
105-110
ISSN
0167-8140 (ISSN-L)
DOI
10.1016/j.radonc.2022.10.034
OpenAlex
W4308364495
Cited by
14
References
34
Citations by year
2026: 5 · 2025: 8 · 2023: 1
FWCI
1.53
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Radiotherapy and Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
Topics
  • Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
Keywords
head and neck cancer, neck irradiation, late radiation toxicity, radiotherapy optimization, external validation
MeSH terms
Head and Neck Neoplasms, Humans, Hypothyroidism, Radiation Injuries, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated

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