- Volume 17 Issue 10
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Thyroid Function after Postoperative Radiation Therapy in Patients with Breast Cancer
- Wolny-Rokicka, Edyta (Department of Radiotherapy, Regional Clinical Hospital in Zielona Gora) ;
- Tukiendorf, Andrzej (Department of Epidemiology and Silesia Cancer Registry) ;
- Wydmanski, Jerzy (Department of Radiotherapy, Center of Oncology, Maria Sklodowska-Curie Memorial Institute) ;
- Roszkowska, Danuta (Department of Physics, Regional Clinical Hospital in Zielona Gora) ;
- Staniul, Boguslaw (Department of Surgery, Regional Hospital in Sulechow) ;
- Zembron-Lacny, Agnieszka (University of Zielona Gora, Faculty of Medicine and Health Sciences)
- Published : 2016.10.01
Objective: The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy. Materials and Methods: Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group - 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients).The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1-40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients. Results: Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities). Conclusion: Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.
Thyroid disorders;external beam radiation;breast cancer;hypothyroidism
- Koc M, Capoglu I, Unuvar N (2001). Does the tamoxifen increase thyroid dysfunction after loco-regional irradiation of breast cancer? Radiother Oncol, 59, 361-62. https://doi.org/10.1016/S0167-8140(01)00284-5
- Kuijpens JL, Nyklictek I, Louwman MW, et al (2005). Hypothyroidism might be related to breast cancer in post-menopausal women. Thyroid, 15, 1253-9. https://doi.org/10.1089/thy.2005.15.1253
- Kuten A, Lubochitski R, Fishman G, Dale J, Stein ME (1996). Postradiotherapy hypothyroidism; Radiation dose response and chemotherapeutic radiosensitization at less than 40Gy. J Surg Oncol, 61, 281-83. https://doi.org/10.1002/(SICI)1096-9098(199604)61:4<281::AID-JSO10>3.0.CO;2-9
- Laway BA, Shafi KM, Majid S, et al (2012).Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland. Indian J of Endocrinol Metab, 16, 329-31. https://doi.org/10.4103/2230-8210.95658
- Rasmusson B, Rasmussen UF, Hegedus L, et al (1987). Thyroid function in patients with breast cancer. J Cancer Clin Oncol, 23, 553-56. https://doi.org/10.1016/0277-5379(87)90319-1
- Mittra I, Hayward JL (1974).Hypothalamic-pituitary-thyroid axis in breast cancer. Lancet, 1, 885-89.
- Mi Young Kim, Tosol Yu, Hong-Gyun Wu (2014).Dose-volumetric parameters for predicting hypothyroidismafter radiotherapy for head and neck cancer. Jpn J ClinOncol, 44, 331-37 https://doi.org/10.1093/jjco/hyt235
- Murthy V, Narang K, Ghosh-Laskar S, et al (2014). Hypothyroidism after 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for head and neck cancers: prospective data from 2 randomized controlled trials. Head Neck, 36, 1573-80. https://doi.org/10.1002/hed.23482
- National Comprehemsive Cancer Network (2015). Availableat:http://www.nccn.org/ Accessed version 1.2015 et 2.2015.
- Schimpff SC, Diggs CH, Wiswell JG, Salvatore PC,Wiernik PH (1980). Radiation-related thyroid dysfunction. Implications for the treatment of Hodgkin's disease. Ann Intern Med, 92, 91-8. https://doi.org/10.7326/0003-4819-92-1-91
- Shering SG, Zbar AP, Moriatry M (1996).Thyroid disorders and breast cancer. Eur J Cancer Prev, 5, 504-6.
- Smith GL, Smith BD, Giordano SH, et al (2008). Risk of hypothyroidism in older breast cancer patients treated with radiation. Cancer, 112,1371-9. https://doi.org/10.1002/cncr.23307
- Tamura K, Shimaoka K, Friedman M (1981). Thyroid abnormalities associated with treatment of malignant lymphoma. Cancer, 47, 2704-11. https://doi.org/10.1002/1097-0142(19810601)47:11<2704::AID-CNCR2820471129>3.0.CO;2-G
- Bernat L, Hrusak D (2014).Hypothyroidism after radiotherapy of head and neck cancer. J Craniomaxillofac Surg, 42, 356-61. https://doi.org/10.1016/j.jcms.2013.09.009
- Biondi B, Cooper DS (2008). The clinical significance of subclinical thyroid dysfunction. Endocr Rev, 29, 76-131. https://doi.org/10.1210/er.2006-0043
- Bruning P, Bonfrer J, De Jong-Bakker M, Nooyen W, Burgers M (1985). Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph nodes. Br J Cancer, 51,659-63. https://doi.org/10.1038/bjc.1985.99
- Chougule A, Kochar B (2011). Thyroid dysfunction following therapeutic external radiation to head and neck cancer. Asian Pac J Cancer Prev, 12, 443-5.
- Alterio D, Jereczek-Fossa BA, Franchi B, et al (2007). Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: a retrospective analysis of seventy-three patients. Int J Radiat Oncol Biol Phys, 67, 144-50. https://doi.org/10.1016/j.ijrobp.2006.08.051
- Beatson GT (1896). On the treatment of inoperable cases of carcinoma of the mama: Suggestions for a new method of treatment, with illustrative cases. Lancet, 148, 162-65. https://doi.org/10.1016/S0140-6736(01)72384-7
- Cristofanilli M, Yamamura Y, Kau S-W, et al (2005). Thyroid Hormone and Breast Carcinoma. Cancer, 103, 1122-8. https://doi.org/10.1002/cncr.20881
- Emami B, Lyman J, Brown A, et al (1991). Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys, 21,109-22.
- Feen Ronjom M. (2016). Radiation-induced hypothyroidism after treatment of head and neck cancer. Dan Med J, 63, B5213
- Fuks Z, Glatsteien E, Marsa GW, Bagshaw MA, Kaplan HS (1976). Long-term effects of external radiation on the pituitary and thyroid glands. Cancer, 37, 1152. https://doi.org/10.1002/1097-0142(197602)37:2+<1152::AID-CNCR2820370826>3.0.CO;2-T
- Fujiwara M, Kamikonya N, Odawara S et al (2015). The threshold of hypothyroidism after radiation therapy for head and neck cancer: a retrospective analysis of 116 cases. J Radiat Res, 56, 577-82. https://doi.org/10.1093/jrr/rrv006
- Glatstein E, McHardy-Young S, Brast N, Eltringham JR, Kriss JP (1971). Alterations in serum thyrotropin (TSH) and thyroid function following radiotherapy in patients with malignant lymphoma. J Clin Endocrinol Metab, 32, 833-41. https://doi.org/10.1210/jcem-32-6-833
- Hellevik AI, Asvold BO, Bjoro T, (2009).Thyroid function and cancer risk: a prospective population study. Cancer Epidemiol Biomarkers Prev, 18, 570-4. https://doi.org/10.1158/1055-9965.EPI-08-0911
- Huang J, Walker R, Groome PG, Shelley W, Mackillop WJ (2001). Risk of thyroid carcinoma in a female population after radiotherapy for breast carcinoma. Cancer, 92, 1411-18. https://doi.org/10.1002/1097-0142(20010915)92:6<1411::AID-CNCR1464>3.0.CO;2-9
- Jereczek-Fossa BA, Alterio D, Jassem J, et al (2004). Radiotherapy-induced thyroid disorders. Cancer Treat Rev, 30, 369-84 https://doi.org/10.1016/j.ctrv.2003.12.003
- Johansen S, Reinertsen KV, Knutstad K, Olsen DR, Fossa SD (2011). Dose distribution in the thyroid gland following radiation therapy of breast cancer - A retrospective study. Radiat Oncol, 6, 68. https://doi.org/10.1186/1748-717X-6-68
- Kilbane MT, Ajjan RA, Weetman AP, et al (2000). Tissue iodine content and serum-mediated 125I uptake-blocking activity in breast cancer. J Clin Endocrinol Metab, 3,1245-50.
- Tunio MA, Al Asiri M, Bayoumi Y, et al (2015). Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study. J Can Res Ther, 11, 684-9. https://doi.org/10.4103/0973-1482.167613
- Turner SL, Tiver KW, Boyages SC (1995). Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys, 31, 279-83. https://doi.org/10.1016/0360-3016(93)E0112-J
- Venturi S, Donati FM, Venturi A, et al (2000). Role of iodine in evolution and carcinogenesis of thyroid, breast and stomach. Adv Clin Pathol, 4, 11-17.
- Yoden E, Maruta T, Soejima T, et al (2001). Hypothyroidism after radiotherapy to the neck. Int J Radiat Oncol Biol Phys, 51, 337-38.