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Multicenter Study
. 2024 Oct:157:106976.
doi: 10.1016/j.oraloncology.2024.106976. Epub 2024 Aug 6.

Incidence and risk factors associated with the development of hypothyroidism after postoperative chemoradiotherapy for head and neck cancer patients with high-risk features: Supplementary analysis of JCOG1008

Hidetoshi Shimizu  1 , Takeshi Kodaira  2 , Naomi Kiyota  3 , Ryuichi Hayashi  4 , Hiroshi Nishino  5 , Yukinori Asada  6 , Hiroki Mitani  7 , Yuuji Hirayama  8 , Yusuke Onozawa  9 , Naoki Nishio  10 , Nobuhiro Hanai  11 , Akira Ohkoshi  12 , Hiroki Hara  13 , Nobuya Monden  14 , Masato Nagaoka  15 , Shujiro Minami  16 , Takashi Fujii  17 , Kaoru Tanaka  18 , Akihiro Homma  19 , Seiichi Yoshimoto  20 , Nobuhiko Oridate  21 , Koichi Omori  22 , Tsutomu Ueda  23 , Kenji Okami  24 , Hirokazu Uemura  25 , Kiyoto Shiga  26 , Mitsuhiko Nakahira  27 , Takahiro Asakage  28 , Yuki Saito  29 , Keita Sasaki  30 , Ryo Kitabayashi  31 , Satoshi Ishikura  32 , Yasumasa Nishimura  33 , Makoto Tahara  34
Affiliations
Multicenter Study

Incidence and risk factors associated with the development of hypothyroidism after postoperative chemoradiotherapy for head and neck cancer patients with high-risk features: Supplementary analysis of JCOG1008

Hidetoshi Shimizu et al. Oral Oncol. 2024 Oct.

Abstract

Background and purpose: Hypothyroidism is a recognized late adverse event following radiotherapy for head and neck cancer (HNC). In the JCOG1008 trial, we treated patients with high-risk HNC with postoperative chemoradiotherapy. We aimed to elucidate factors associated with hypothyroidism by analyzing the JCOG1008 data.

Materials and methods: In 2012-2018, 261 patients from 28 institutions were enrolled in JCOG1008. Thyroid function tests were conducted to assess hypothyroidism, including free thyroxine (FT4) and thyroid-stimulating hormone assays. Hypothyroidism was defined as Grade 2 or higher in CTCAE v4.0. Various clinical and dosimetric parameters were analyzed. In radiotherapy, there were no dose constraints for the thyroid. Multivariable analysis was conducted on these variables to identify predictive factors for hypothyroidism.

Results: The analysis included 162 patients (57 with 3D-CRT and 105 with IMRT), with a median follow-up of 4.7 years (0.3-9.3 years). Among these, 27 (16.7 %) developed hypothyroidism within 2 years after radiotherapy. In a multivariable analysis, the weekly cisplatin [OR=7.700 (CI: 1.632-36.343, p = 0.010)] and baseline FT4 [OR=0.009 (CI: <0.001-0.313, p = 0.010)] were significantly associated with hypothyroidism in the IMRT group. Regarding dosimetric characteristics, V60Gy [OR=1.069 (CI: 0.999-1.143, p = 0.054)] was potentially associated with the development of hypothyroidism.

Conclusion: The study revealed that the incidence of hypothyroidism within 2 years after postoperative chemoradiotherapy for high-risk HNC was 16.7 % based on analytical results from prospective clinical trials.

Keywords: Hypothyroidism; Intensity modulated radiation therapy; JCOG1008; Randomized controlled trial; Secondary analysis; Weekly cisplatin; high-risk postoperative head and neck cancer (HNC).

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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