Comparison of Thyroid Toxicity Profiles in Head and Neck Cancer Patients Irradiated by 3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy

Abstract

ABSTRACT Background: In spite of recent technical advances in the radiation field, exposure to non-target organs such as the thyroid gland remains unavoidable in locally advanced head and neck cancer (LAHNC) planning, which is associated with late toxicities, and this may affect the lifestyle of cancer survivors. Aim: The purpose of this study was to estimate the incidence of thyroid toxicity in LAHNC patients treated with three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). To establish its correlation, we have analyzed thyroid profile levels, DVH, and the doses of radiation received by the thyroid volume in both radiotherapy planning methods. Material and Method: Sixty patients with LAHNC enrolled and were divided into two groups treated with 3D-CRT (group A) and IMRT (group B). The patient’s thyroid function test, which consisted of serumT3, T4, and TSH, was done before starting radiotherapy and at 6 months and 12 months follow-up. Absolute thyroid volume, maximum dose, minimum dose, mean dose to the thyroid gland, and percentage of thyroid volume receiving as V10, V20, V30, V40, and V50 were studied. Results: After 6-month post-RT, 6.7% of patients in group A showed biochemical hypothyroidism, whereas biochemical hypothyroidism, sub-clinical hypothyroidism, and hyperthyroidism were observed in 10%, 3.3%, and 10% patients of group B, respectively. After 12 months post-RT, 23.3% of patients in group A showed hypothyroidism. In the 3DCRT group, mean T3 was significantly higher for patients with no hypothyroidism (P < 0.05). Mean T4 was observed to be significantly lower in both the groups in hypothyroid patients (P < 0.05). Mean TSH was significantly higher for hypothyroid patients in the IMRT group (P > 0.01). The difference in thyroid volume and thyroid dose was observed to be statistically significant (P < 0.05). Conclusion: The incidence of thyroid toxicity may be decreased by sparing the volume of the thyroid gland and the thyroid dose kept to a minimum. As per dosimetric parameters, >V40 may predict the risk of developing hypothyroidism after irradiation in LAHNC patients. We recommend regular thyroid function tests on follow-up visits of irradiated patients of LAHNC.