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

• Published in: Oral oncology 2024-10, Vol.157, p.106976, Article 106976
• Main Authors: Shimizu, Hidetoshi, Kodaira, Takeshi, Kiyota, Naomi, Hayashi, Ryuichi, Nishino, Hiroshi, Asada, Yukinori, Mitani, Hiroki, Hirayama, Yuuji, Onozawa, Yusuke, Nishio, Naoki, Hanai, Nobuhiro, Ohkoshi, Akira, Hara, Hiroki, Monden, Nobuya, Nagaoka, Masato, Minami, Shujiro, Fujii, Takashi, Tanaka, Kaoru, Homma, Akihiro, Yoshimoto, Seiichi, Oridate, Nobuhiko, Omori, Koichi, Ueda, Tsutomu, Okami, Kenji, Uemura, Hirokazu, Shiga, Kiyoto, Nakahira, Mitsuhiko, Asakage, Takahiro, Saito, Yuki, Sasaki, Keita, Kitabayashi, Ryo, Ishikura, Satoshi, Nishimura, Yasumasa, Tahara, Makoto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Chemoradiotherapy - adverse effects; Female; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - therapy; high-risk postoperative head and neck cancer (HNC); Humans; Hypothyroidism; Hypothyroidism - epidemiology; Hypothyroidism - etiology; Incidence; Intensity modulated radiation therapy; JCOG1008; Male; Middle Aged; Randomized controlled trial; Risk Factors; Secondary analysis; Weekly cisplatin
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2024.106976

•Secondary analysis related to hypothyroidism (HT) in JCOG1008.•This is a HT report in a prospective study of postoperative chemoradiotherapy for head and neck cancer (HNC) patient.•In total, 16.7 % patients developed HT within 2 years after radiotherapy.•Weekly cisplatin using intensity-modulated radiotherapy was a HT factor.•V60Gy potentially associated with the development of HT by intensity modulated radiation therapy. 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. 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. 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: