Association of thyroid radiation dose with thyroid dysfunction in patients with locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy followed by maintenance immunotherapy

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-05-04 DOI:10.1016/j.lungcan.2025.108574

Gowoon Yang , Hong In Yoon , Sun Min Lim , Min Hee Hong , Jaeho Cho , Chang Geol Lee , Byoung Chul Cho , Hye Ryun Kim , Kyung Hwan Kim

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引用次数: 0

Abstract

Background and purpose

We investigated whether incidental irradiation to the thyroid increased the risk of thyroid dysfunction among patients with non-small cell lung cancer (NSCLC) undergoing concurrent chemoradiotherapy (CCRT) followed by maintenance immunotherapy (IO).

Materials and methods

This was a retrospective study of 250 patients diagnosed with locally advanced NSCLC during 2014–2022 who were treated with definitive CCRT followed by maintenance IO. The primary endpoint was the incidence of thyroid dysfunction, which we compared between patients with irradiation of the supraclavicular fossa (the SCFi group) and those without (the non-SCFi group).

Results

By a median follow-up time of 16.6 months, 23/64 patients (35.9%) in the SCFi group and 27/186 patients (14.5%) in the non-SCFi group developed thyroid dysfunction (P < 0.001). The 3-year cumulative incidence of thyroid dysfunction was 54.9% in the SCFi group and 17.0% in the non-SCFi group (P < 0.001). A higher thyroid volume exposed to 10 Gy of radiation (V_10Gy) significantly and independently predicted an increased risk of thyroid dysfunction (hazard ratio, 2.82). The 3-year cumulative incidence of thyroid dysfunction was 67.9% in patients with V_10Gy ≥ 19.8% and 25.6% in patients with V_10Gy < 19.8% (P < 0.001). Via recursive-partitioning analysis, patients were classified into three risk groups based on the V_10Gy cutoff of < 19.8% and age cutoff of ≥ 75 years. The 3-year cumulative incidence of thyroid dysfunction was the highest (74.0%) in the high-risk group (P < 0.001).

Conclusion

Incidental irradiation of the thyroid during CCRT is associated with an increased risk of thyroid dysfunction during maintenance IO. This supports the need to minimize the thyroid dose.

查看原文本刊更多论文

同步放化疗后维持免疫治疗的局部晚期非小细胞肺癌患者甲状腺辐射剂量与甲状腺功能障碍的关系

背景和目的本研究探讨了在同步放化疗（CCRT）后进行维持免疫治疗（IO）的非小细胞肺癌（NSCLC）患者中，偶然照射甲状腺是否会增加甲状腺功能障碍的风险。材料和方法回顾性研究了2014-2022年诊断为局部晚期NSCLC的250例患者，这些患者接受了明确的CCRT和维持性IO治疗。主要终点是甲状腺功能障碍的发生率，我们比较了锁骨上窝照射组（SCFi组）和未照射组（非SCFi组）的患者。结果中位随访时间为16.6个月，SCFi组有23/64例（35.9%），非SCFi组有27/186例（14.5%）出现甲状腺功能障碍(P <；0.001)。SCFi组3年累积甲状腺功能障碍发生率为54.9%，非SCFi组为17.0% (P <；0.001)。较高的甲状腺体积暴露于10Gy的辐射（V10Gy）显著且独立地预测甲状腺功能障碍的风险增加（风险比，2.82）。V10Gy≥19.8%的患者3年累积甲状腺功能障碍发生率为67.9%，V10Gy <的患者为25.6%；19.8% (P <；0.001)。通过递归划分分析，以V10Gy临界值为基础，将患者分为3个风险组；19.8%，年龄界限≥75岁。高危组3年累积甲状腺功能障碍发生率最高（74.0%）(P <；0.001)。结论CCRT期间甲状腺偶发照射与维持期甲状腺功能障碍风险增加有关。这说明需要尽量减少甲状腺剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.