Long-term incidence of hypothyroidism after radiotherapy in patients with head-and-neck cancer

International Journal of Radiation Oncology, Biology, Physics
R TellR Lewensohn

Abstract

To determine the long-term incidence of postirradiation hypothyroidism (HT) in patients with head-and-neck cancer. The incidence of overt HT was assessed prospectively in 391 patients with nonthyroid head-and-neck cancer admitted for radiotherapy (RT) consecutively between 1990 and 1996. Eighty-three patients were excluded from the analysis because of known thyroid disease before treatment (n = 27), no RT was given (n = 15), or inadequate follow-up (n = 41). Overt HT was defined as increased thyroid-stimulating hormone (TSH) in combination with decreased fT4/T4 or in combination with initiation of thyroxine replacement therapy. With a median follow-up of 4.2 years (range, 3 months to 10.9 years) for 308 evaluable patients, the 5- and 10-year Kaplan-Meier actuarial risks of HT were 20% and 27%, respectively. The median time until development of HT was 1.8 years (3 months to 8.1 years). Multivariate analysis showed that patients with bilateral RT to the neck had a higher risk of HT in comparison with unilateral neck RT (relative hazard, 0.37; p = 0.02). The addition of surgery to RT increased the overall risk of HT (p < 0.001); and if surgery involved the thyroid gland, the relative hazard was 4.74 (p < 0.001). For an elevated pr...Continue Reading

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