Impact of Thyroid Dose on Radiation-induced Hypothyroidism in Early Glottic Cancer Patients Undergoing Volumetric Modulated Arc Therapy

Abstract

Background/aim: To evaluate the incidence of radiation-induced hypothyroidism (RIHT) and its association with thyroid dose in patients undergoing volumetric modulated arc therapy (VMAT) for early glottic cancer. Patients and methods: We retrospectively reviewed 23 patients with early glottic cancer who received VMAT between 2018 and 2023. All included patients had normal baseline thyroid function tests. RIHT was defined as an increase in thyroid-stimulating hormone levels with or without a decrease in free-T4 or T3 levels. Dose-volume parameters (DVPs) of the thyroid gland, including mean dose and the relative thyroid volume receiving at least 10-60 Gy (V-10Gy-V-60Gy), were analyzed for correlation with RIHT. Results: The median follow-up time was 36.4 months, during which all patients survived. The 1-year and 3-year local failure-free survival rates were 91.3% and 82.4%, respectively. The median mean dose was 25.2 Gy. RIHT developed in five patients (21.7%), with a median onset time of 16.7 months after VMAT. Among them, one patient received thyroid hormone therapy. Among the DVPs, V-10Gy>70% was significantly associated with a higher risk of RIHT. The 2-year rates of RIHT were 6.2% in patients with V-10Gy <= 70% and 44.4% in patients with V-10Gy>70% (p=0.006). Age and underlying diseases were not associated with RIHT. Conclusion: A considerable proportion of patients developed RIHT after VMAT for early glottic cancer. The thyroid gland should be recognized as an important organ at risk. For VMAT planning, V-10Gy may serve as a useful optimization constraint.