Abstract
ObjectiveThe objective of this study was to evaluate the incidence of hypothyroidism with adjuvant treatment in oral tongue carcinoma patients treated primarily with surgery.Materials and methodsA retrospective review was carried out to analyze hypothyroidism incidence and its relation to adjuvant treatment (radiation/radio-chemotherapy) in oral tongue carcinoma after the primary surgical ablation and neck dissection. Hypothyroidism was analyzed in relation with dose of radiation, gender, and adjuvant treatment modality.ResultsThe study analyzed the patients who were treated between January 2012 and June 2015. Among 705 patients with carcinoma of the tongue treated primarily with wide local excision and neck dissection, 383 received adjuvant treatment. A total of 215 patients received radiation, and 168 received concurrent radio-chemotherapy. Of 378 patients, 78 developed hypothyroidism during follow-up: 27 patients received concurrent radio-chemotherapy, and the remaining 51 received only radiation. Lower neck received 40–48 Gy in 2 patients, 50 Gy in 74 patients, and 60–70 Gy and concurrent radio-chemotherapy in 27 patients. Median follow-up was 32 months. Hypothyroidism occurred in 21.5% of patients with squamous cell carcinoma of the oral tongue. The minimum period to develop hypothyroidism was 3 months in this study. Gender and adjuvant treatment were not found to be significant for the incidence of hypothyroidism.ConclusionsA significant number of patients with carcinoma of the tongue who receive adjuvant treatment will develop hypothyroidism, hence frequent monitoring of thyroid function is advised during follow-up.
Highlights
Carcinoma of the oral cavity is among the top three types of cancers in India,[1,2] and oral cancer accounts for about 30% of all types of cancer.[2,3] Standard treatment of carcinoma of the tongue involves wide local excision with neck dissection, followed by adjuvant treatment depending upon stage and pathological risk factors
A significant number of patients with carcinoma of the tongue who receive adjuvant treatment will develop hypothyroidism, frequent monitoring of thyroid function is advised during follow-up
The study is a single-institution retrospective analysis of 705 consecutive patients with a biopsy-proven squamous cell carcinoma of the oral tongue at the Basavatarakam Indo-American Cancer Hospital and Research Institute in Hyderabad, India between January 2012 and June 2015 who were treated with surgery, i.e. wide local excision with neck dissection, followed by adjuvant RT and concurrent cisplatinbased chemotherapy according to the stage of the disease and histopathological risk factors discussed at a multidisciplinary tumor board
Summary
Carcinoma of the oral cavity is among the top three types of cancers in India,[1,2] and oral cancer accounts for about 30% of all types of cancer.[2,3] Standard treatment of carcinoma of the tongue involves wide local excision with neck dissection, followed by adjuvant treatment depending upon stage and pathological risk factors. External beam radiotherapy (EBRT) is often associated with significant longterm morbidity, which includes chronic xerostomia and fibrosis of the soft tissues of the neck.[4]. The incidence of hypothyroidism varies with the risk factors such as surgery, radiation dose, volume of thyroid tissue irradiated, and duration of patient follow-up. Clinicians often overlook hypothyroidism as a complication of management of carcinoma in the oral cavity, and it has been pointed out that thyroid function is rarely evaluated at post treatment follow-up.[7]
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