CAJ | 학술논문

目的探讨头颈部肿瘤患者接受调强放射治疗(IMRT)后出现甲状腺功能减退(HT)与患者临床特征参数、剂量体积直方图(DVH)参数的相关性.方法收集28例接受头颈部IMRT(颈部照射剂量≥40 Gy)联合化疗的肿瘤患者资料.治疗前后及随访观察中监测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4).原发性HT定义为血清TSH高于正常值的上限伴或不伴有FT3/FT4的降低.基于放疗计划系统DVH,记录每一位患者甲状腺体积(TV)、甲状腺平均照射剂量(MTD)、最大点剂量(Dmax)、甲状腺接受≥5～ 50 Gy的相对体积(表示为Vx,x=5 ～50,5 Gy为间隔).回顾性分析患者年龄、性别、化疗、TV、MTD、Dmax及各DVH参数与HT的相关性.结果全组患者治疗前血清TSH、FT3和FT4中位数分别为1.51 μU/ml、5.38和18.57 pmol/L.中位随访15个月(3～ 57月),14例(50.0％)患者出现HT,出现HT的中位时间为放疗后8个月(2～ 23月).患者首次监测发现HT时间点的TSH、FT3和FT4中位数分别为7.48 μU/ml(4.67～60.11 μU/ml)、4.05 pmol/L (0.40～5.77 pmol/L)和12.32 pmol/L(4.12 ～21.25 pmol/L),HT患者的TSH较治疗前明显升高(P＜0.01).HT患者的TV中位数为17.76 cm3,显著低于未出现HT患者的20.21 cm3(Z=-2.154,P＜0.05).单因素分析显示患者年龄和V40与HT的发生风险相关(x2=11.340、4.102,OR =30.0、9.17,P＜0.05).多因素分析证实患者年龄、V40均是HT的独立影响因素(OR =34.7、6.13,P＜0.05).结论头颈部肿瘤患者IMRT后出现HT伴随TSH的显著增高.低龄、甲状腺体积较小的患者,甲状腺V40大于80％是发生HT的高风险因素.
목적 탐토두경부종류환자접수조강방사치료(IMRT)후출현갑상선공능감퇴(HT)여환자림상특정삼수、제량체적직방도(DVH)삼수적상관성.방법 수집28례접수두경부IMRT(경부조사제량≥40 Gy)연합화료적종류환자자료.치료전후급수방관찰중감측혈청촉갑상선격소(TSH)、유리삼전갑상선원안산(FT3)화유리갑상선소(FT4).원발성HT정의위혈청TSH고우정상치적상한반혹불반유FT3/FT4적강저.기우방료계화계통DVH,기록매일위환자갑상선체적(TV)、갑상선평균조사제량(MTD)、최대점제량(Dmax)、갑상선접수≥5～ 50 Gy적상대체적(표시위Vx,x=5 ～50,5 Gy위간격).회고성분석환자년령、성별、화료、TV、MTD、Dmax급각DVH삼수여HT적상관성.결과 전조환자치료전혈청TSH、FT3화FT4중위수분별위1.51 μU/ml、5.38화18.57 pmol/L.중위수방15개월(3～ 57월),14례(50.0％)환자출현HT,출현HT적중위시간위방료후8개월(2～ 23월).환자수차감측발현HT시간점적TSH、FT3화FT4중위수분별위7.48 μU/ml(4.67～60.11 μU/ml)、4.05 pmol/L (0.40～5.77 pmol/L)화12.32 pmol/L(4.12 ～21.25 pmol/L),HT환자적TSH교치료전명현승고(P＜0.01).HT환자적TV중위수위17.76 cm3,현저저우미출현HT환자적20.21 cm3(Z=-2.154,P＜0.05).단인소분석현시환자년령화V40여HT적발생풍험상관(x2=11.340、4.102,OR =30.0、9.17,P＜0.05).다인소분석증실환자년령、V40균시HT적독립영향인소(OR =34.7、6.13,P＜0.05).결론 두경부종류환자IMRT후출현HT반수TSH적현저증고.저령、갑상선체적교소적환자,갑상선V40대우80％시발생HT적고풍험인소.
Objective To determine the clinical and dosimetric factors associated with radiation-induced hypothyroidism (HT) in head-and-neck cancer patients treated with intensity-modulated radiotherapy (IMRT).Methods The clinical data of 28 head-and-neck cancer patients undergoing IMRT (with the prescribed radiation dose of neck ≥ 40 Gy) plus chemotherapy were retrospectively recruited.The serum levels of thyroid-stimulating hormone (TSH),free triiodo-thyronine (FT3),and free thyroxine (FT4) of each patient were recorded basally and at different times after the end of therapy.Primary HT was defined as increased TSH with or without decreased FT3 and/or FT4.Based on each patient's dosevolume histogram (DVH),the volume percentages of thyroid absorbing 5-50 Gy at interval of 5 Gy were estimated (marked as Vx,x =5-50) together with the mean thyroid dose (MTD),maximum dose (Dmax) and thyroid volume (TV).To evaluate the clinical and dosimetric factors associated with HT,univariate and multivariate logistic regression analysis were performed.Results The median serum levels of TSH,FT3,and FT4 before treatment were 1.51 μU/ml,5.38 pmol/L,and 18.57 pmol/L,respectively.During the follow-up time of of 15 months (3-57 months),14 patients (50.0％) developed HT,and the median time for firstly detected HT was 8 months (2-23 months) after treatment.The median serum levels of TSH,FT3,and FT4 when HT was firstly detected were 7.48 uU/ml (4.67-60.11 μU/ml),4.05 pmol/L (0.40-5.77 pmol/L),and 12.32 pmol/L (4.12-21.25 pmol/L) respectively.There was a significant increasing in TSH level in patients with HT during the follow-up (P ＜ 0.05).The TV of the patients with HT was significantly lower than those without HT (Z =-2.154,P ＜ 0.05).Univariate analysis showed that younger age and V40 ≥ 80％ were associated with a higher risk of HT (x2 =11.340,4.102; OR =30.0,9.17; P ＜ 0.05).Multivariate analysis confirmed that age and V40 were the independent predictors (OR =34.7,6.13 ; P ＜ 0.05).Conclusions HT after IMRT for head-and-neck cancer is accompanied by elevated TSH levels.Younger age,smaller thyroid volume,and V40 ≥ 80％ have been identified as risk factors for HT after IMRT.