THYROID DYSFUNCTION IN PATIENTS TREATED WITH RT / CHEMO-RT FOR NON-THYROID HEAD & NECK CANCERS Dr.T.Sujit Dr....
INTRODUCTION <ul><li>Hypothyroidism, the most common radiation-induced thyroid dysfunction, affects 20-30% of patients ...
OBJECTIVES <ul><li>To determine the incidence of </li></ul><ul><ul><ul><li>subclinical hypothyroidism </li></ul></ul><...
STUDY POPULATION <ul><li>50 patients who were newly diagnosed with non thyroid, non -metastatic H & N cancer were entered...
INCLUSION CRITERIA <ul><li>Patients with proven, non-thyroid , stage I – IV non-metastatic head & neck cancers, who are to...
EXCLUSION CRITERIA <ul><li>Patients with metastatic disease </li></ul><ul><li>Performance status 3 or 4 ( ECOG ) </li></u...
STUDY PROTOCOL <ul><li>Pre-treatment evaluation included physical examination including dental examination; haemogram , ...
STUDY PROTOCOL <ul><li>The normal values of thyroid hormones was taken as </li></ul><ul><li> follows : </li></ul><ul><u...
RESULTS <ul><li>INCIDENCE: </li></ul><ul><li>10 of the 50 patients (20%) in the study population were detected to have su...
RESULTS <ul><li>TIME TO INCIDENCE: </li></ul><ul><ul><li>All 10 pts showed a transient rise in T3 and T4 levels </li><...
 
RESULTS <ul><li>VARIABLES ANALYSED : </li></ul><ul><ul><ul><ul><ul><li>Gender </li></ul></ul></ul></ul></ul><ul><ul><ul>...
100.0 80.0 20.0 % 50 40 10 Count TOTAL 2 2 0 Count Others 2 2 0 Count Unknown primary 8 2 6 Count Hypopharynx 10 10 0 Cou...
100.0 80.0 20.0 % 50 40 10 Count Total 6 4 2 Count N3 8 4 4 Count N2 26 22 4 Count N1 10 10 0 Count N0 No Yes Total HYPOT...
RESULTS <ul><ul><ul><li>Hypopharyngeal tumors </li></ul></ul></ul><ul><ul><ul><li>T 3 tumors </li></ul></ul></ul><ul><ul><...
 
DISCUSSION <ul><li>Hypothyroidism may develop in patients with head and neck cancers through a number of potential mechani...
CONCLUSION <ul><li>Incidence of subclinical hypothyroidism in non thyroid head & neck cancer patients treated with RT / ch...
 
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Nat Aroicon 2007 Sujit 1.2

My thesis work; presented in National AROICON 2007.
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Nat Aroicon 2007 Sujit 1.2

  • 1. THYROID DYSFUNCTION IN PATIENTS TREATED WITH RT / CHEMO-RT FOR NON-THYROID HEAD & NECK CANCERS Dr.T.Sujit Dr. V.Nagarajan MD , DMRT HoD , Radiation Oncology Dr.M.Nagarajan MD , DNB Consultant Radiation Oncologist G.KUPPUSWAMY NAIDU MEMORIAL HOSPITAL , COIMBATORE
  • 2. INTRODUCTION <ul><li>Hypothyroidism, the most common radiation-induced thyroid dysfunction, affects 20-30% of patients following curative radiotherapy to the neck region, with approximately half of the events occurring within the first 5 years after therapy . </li></ul><ul><li>Reported incidences of sub-clinical radiation induced hypothyroidism vary from 15 – 66% . </li></ul><ul><li>Published incidence of radiation induced overt hypothyroidism varies substantially depending on the dose of radiation, volume of thyroid included in radiation portals, addition of chemotherapy, addition of surgery, age, the duration of follow up or even the definition of hypothyroidism </li></ul>
  • 3. OBJECTIVES <ul><li>To determine the incidence of </li></ul><ul><ul><ul><li>subclinical hypothyroidism </li></ul></ul></ul><ul><ul><ul><li>clinical hypothyroidism </li></ul></ul></ul><ul><li> following RT to head & neck region </li></ul><ul><li>To determine the time to incidence of </li></ul><ul><ul><ul><li>subclinical hypothyroidism </li></ul></ul></ul><ul><ul><ul><li>clinical hypothyroidism </li></ul></ul></ul><ul><li>following RT to head &neck region </li></ul><ul><li>To determine the variables significantly affecting thyroid function after RT to the head & neck region. </li></ul>
  • 4. STUDY POPULATION <ul><li>50 patients who were newly diagnosed with non thyroid, non -metastatic H & N cancer were entered into the study in a prospective manner. </li></ul><ul><li>Study duration : One year. </li></ul>
  • 5. INCLUSION CRITERIA <ul><li>Patients with proven, non-thyroid , stage I – IV non-metastatic head & neck cancers, who are to be treated with RT ± chemo / surgery. </li></ul><ul><li>Performance status 0 – 2 ( ECOG ) </li></ul><ul><li>Normal pre-treatment thyroid profile. </li></ul><ul><li>Signed consent for entry into study. </li></ul>
  • 6. EXCLUSION CRITERIA <ul><li>Patients with metastatic disease </li></ul><ul><li>Performance status 3 or 4 ( ECOG ) </li></ul><ul><li>Abnormal pre-treatment thyroid profile </li></ul><ul><li>Patients with h/o prior radiation to head & neck region or chest wall. </li></ul><ul><li>Patients with uncontrolled systemic diseases like Diabetes mellitus or Hypertension. </li></ul><ul><li>Patients on medications which may affect thyroid function either directly or indirectly. </li></ul>
  • 7. STUDY PROTOCOL <ul><li>Pre-treatment evaluation included physical examination including dental examination; haemogram , blood sugar & urea, serum creatinine & bilirubin estimations, CXR. </li></ul><ul><li>Thyroid profile ( Serum T3 , T4 and TSH ) was done : </li></ul><ul><ul><li>before initiation of treatment </li></ul></ul><ul><ul><li>after 30 Gy </li></ul></ul><ul><ul><li>on completion of RT </li></ul></ul><ul><ul><li>3 , 6 and 12 months after completion of RT </li></ul></ul>
  • 8. STUDY PROTOCOL <ul><li>The normal values of thyroid hormones was taken as </li></ul><ul><li> follows : </li></ul><ul><ul><ul><ul><li>Serum T3 : 80 – 200 ng / dl , </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Serum T4 : 5 -14 mcg/dl , </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Serum TSH : 0.5 – 3.1 mIU/ml. </li></ul></ul></ul></ul><ul><li>Based on these values , patients were classified according </li></ul><ul><li>to the measured thyroid hormone levels as biochemically </li></ul><ul><li>hypothyroid, euthyroid and hyperthyroid. </li></ul><ul><li>Patients were also clinically examined for signs of thyroid </li></ul><ul><li>hypo / hyperfunction. </li></ul>
  • 9. RESULTS <ul><li>INCIDENCE: </li></ul><ul><li>10 of the 50 patients (20%) in the study population were detected to have sub-clinical hypothyroidism. </li></ul>NONE OF THE PATIENTS HAD CLINICAL SIGNS OF HYPOTHYROIDISM
  • 10. RESULTS <ul><li>TIME TO INCIDENCE: </li></ul><ul><ul><li>All 10 pts showed a transient rise in T3 and T4 levels </li></ul></ul><ul><ul><li>during the RT period reflecting radiation thyroiditis </li></ul></ul><ul><ul><li>Mean time to incidence of overt hypothyroidism: 7.2 mths </li></ul></ul><ul><ul><li>8 of the 10 patients had elevated TSH levels 6 mths after </li></ul></ul><ul><ul><li>treatment and 2 of the 10 patients showed elevated TSH levels 12 mths after completion of treatment. </li></ul></ul>
  • 12. RESULTS <ul><li>VARIABLES ANALYSED : </li></ul><ul><ul><ul><ul><ul><li>Gender </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Age </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Primary site </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>T stage </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>N stage </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Stage grouping </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>RT dose to primary </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>RT dose to neck </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Addition of chemo or surgery </li></ul></ul></ul></ul></ul>
  • 13. 100.0 80.0 20.0 % 50 40 10 Count TOTAL 2 2 0 Count Others 2 2 0 Count Unknown primary 8 2 6 Count Hypopharynx 10 10 0 Count Larynx 16 14 2 Count Oro-pharyn 12 10 2 Count Oral cavity No Yes Total HYPOTHYROID PRIMARY SITE 100.0 80.0 20.0 % 50 40 10 Count Total 2 2 0 Count TX 6 6 0 Count T4 18 12 6 Count T3 22 18 4 Count T2 2 2 0 Count T0 No Yes Total HYPOTHYROID T STAGE
  • 14. 100.0 80.0 20.0 % 50 40 10 Count Total 6 4 2 Count N3 8 4 4 Count N2 26 22 4 Count N1 10 10 0 Count N0 No Yes Total HYPOTHYROID N STAGE 100.0 80.0 20.0 % 50 40 10 Count Total 16 10 6 Count STAGE 4 22 18 4 Count STAGE 3 12 12 0 Count STAGE 2 No Yes Total HYPOTHYROID STAGE GROUPING
  • 15. RESULTS <ul><ul><ul><li>Hypopharyngeal tumors </li></ul></ul></ul><ul><ul><ul><li>T 3 tumors </li></ul></ul></ul><ul><ul><ul><li>N 2 nodal stage </li></ul></ul></ul><ul><ul><ul><li>Stage IV ( non-metastatic ) </li></ul></ul></ul>Were found to be of at higher risk for developing subclinical hypothyroidism
  • 17. DISCUSSION <ul><li>Hypothyroidism may develop in patients with head and neck cancers through a number of potential mechanisms: </li></ul><ul><li>The thyroid gland ( and its vasculature ) maybe compromised as a result of the advancing tumor itself. </li></ul><ul><li>Surgery in the form of direct surgical trauma to the thyroid or as a result of surgical disruption of blood supply to the thyroid can also result in hypothyroidism. </li></ul><ul><li>Some chemotherapeutic agents like 5-Fluoro Uracil and L- Asparaginase may modify circulating thyroid hormone levels, thus contributing to thyroid dysfunction. </li></ul><ul><li>Radiation therapy has been proposed to cause hypothyroidism by causing damage to the endothelial cells of the thyroid capillary network resulting in both early and delayed radiation injury. </li></ul><ul><li>An alternate hypothesis suggests that radiation induced depletion of stem cells maybe responsible for the acute and late effects of radiation on the thyroid. </li></ul>
  • 18. CONCLUSION <ul><li>Incidence of subclinical hypothyroidism in non thyroid head & neck cancer patients treated with RT / chemo-RT is 20%. </li></ul><ul><li>Sub clinical hypothyroidism may develop in these patients any time between 6 months after treatment to 5 years after treatment. </li></ul><ul><li>Hypopharyngeal site , T3 tumors, N2 nodal stage and stage IV ( non-distant mets ) were risk factors for the development of sub-clinical hypothyroidism. </li></ul><ul><li>Though none of the patients had clinical signs of hypothyroidism, most of them had non-specific symptoms like fatigue which could be attributed to overt hypothyroidism . </li></ul><ul><li>These patients should be monitored for development of clinical hypothyroidism. </li></ul>

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