许昀, 王杰松, 苏光建, 程燕铭, 朱丽丽, 彭荷苇. 预防鼻咽癌根治性放疗后甲状腺功能减退的剂量-体积限制参数的外部验证[J]. 中国肿瘤临床, 2023, 50(13): 667-672. DOI: 10.12354/j.issn.1000-8179.2023.20230194
引用本文: 许昀, 王杰松, 苏光建, 程燕铭, 朱丽丽, 彭荷苇. 预防鼻咽癌根治性放疗后甲状腺功能减退的剂量-体积限制参数的外部验证[J]. 中国肿瘤临床, 2023, 50(13): 667-672. DOI: 10.12354/j.issn.1000-8179.2023.20230194
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Yun Xu, Jiesong Wang, Guangjian Su, Yanming Cheng, Lili Zhu, Hewei Peng. External validation of dose-volume limitation parameters for the prevention of hypothyroidism after radical radiotherapy for nasopharyngeal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(13): 667-672. DOI: 10.12354/j.issn.1000-8179.2023.20230194
Citation: Yun Xu, Jiesong Wang, Guangjian Su, Yanming Cheng, Lili Zhu, Hewei Peng. External validation of dose-volume limitation parameters for the prevention of hypothyroidism after radical radiotherapy for nasopharyngeal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(13): 667-672. DOI: 10.12354/j.issn.1000-8179.2023.20230194
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预防鼻咽癌根治性放疗后甲状腺功能减退的剂量-体积限制参数的外部验证

External validation of dose-volume limitation parameters for the prevention of hypothyroidism after radical radiotherapy for nasopharyngeal carcinoma

    摘要
  • 摘要:
      目的  验证既往研究报道的甲状腺剂量-体积限制参数是否影响患者放疗后原发性甲状腺功能减退（hypothyroidism，HT）的发生。
      方法  选取2018年3月至2019年12月福建省肿瘤医院就诊的符合纳入排除标准的92例鼻咽癌患者，末次随访时间为2022年9月，主要结局为原发性HT，单因素和多因素Cox回归分析既往研究报道的甲状腺剂量-体积限制参数与放疗后HT风险之间的关联。
      结果  中位随访时间为34个月。多因素Cox回归分析显示，调整了年龄、性别和放疗技术后，治疗前甲状腺体积越大（<16 cm3 vs. ≥16 cm3），45 Gy下甲状腺的绝对体积（the absolute volumes of thyroid spared from 45 Gy，VS45）越大（<5 cm3vs. ≥5 cm3）、VS50越大（<8 cm3 vs. ≥8 cm3）以及VS60越大（<10 cm3 vs. ≥10 cm3）能够降低放疗后HT的风险HR （95%CI）分别为0.290（0.099～0.847）、0.320（0.132～0.772）、0.267（0.113～0.633）和 0.376（0.163～0.869）。
      结论   治疗前甲状腺体积<16 cm3应谨慎放疗后HT的发生，甲状腺VS45≥5 cm3、VS50≥8 cm3和VS60≥10 cm3可以作为甲状腺受照剂量限制推荐参数。

     

    Abstract:
      Objective  To validate whether the dose-volume restriction parameters of the thyroid gland in previous studies affect the development of primary hypothyroidism (HT) after radiotherapy.
      Methods  The study included patients with nasopharyngeal carcinoma (NPC) who were treated at Fujian Cancer Hospital between March 2018 and December 2019. The last follow-up was conducted in September 2022, and the main outcome was primary HT. Univariate and multivariate Cox regressions were performed to analyze the association between thyroid dose-volume limitation parameters reported in previous studies and the risk of HT after radiotherapy.
      Results  In this study, 92 NPC patients were included, with a median follow-up time of 34 months. Multivariate Cox regression analysis showed, after adjustment for age, sex, and radiation technology, higher thyroid volume before treatment (<16 cm3 vs. ≥16 cm3), higher absolute volume of thyroid spared from 45 Gy (VS45) (<5 cm3 vs. ≥5 cm3), higher VS50 (<8 cm3 vs. ≥8 cm3), and higher VS60 (<10 cm3 vs. ≥10 cm3) could decreased the risk of HT after radiotherapy HR (95%CI) were 0.290 (0.099−0.847), 0.320 (0.132−0.772), 0.267 (0.113−0.633), and 0.376 (0.163−0.869), respectively).
      Conclusions  We should be more cautious about the occurrence of HT after radiotherapy for thyroid volume <16 cm3 before treatment. Thyroid VS45 ≥5 cm3, VS50 ≥8 cm3, and VS60 ≥10 cm3 can be recommended for treatment planning.

     

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