방사선의학 웹진

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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 (V10Gy) 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 V10Gy ≥ 19.8% and 25.6% in patients with V10Gy < 19.8% (P < 0.001). Via recursive-partitioning analysis, patients were classified into three risk groups based on the V10Gy 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.

그림 SCF 조사 여부에 따른 갑상선 기능 이상 누적 발병률. SCF 조사군(SCFi)과 비조사군(non-SCFi) 간에 유의한 차이를 보임.

그림 갑상선 V10Gy≥19.8% 군과 V10Gy<19.8% 군 간의 갑상선 기능 이상에 대한 누적 발병률.

Affiliations

Gowoon Yang 1, Hong In Yoon 2, Sun Min Lim 3, Min Hee Hong 3, Jaeho Cho 2, Chang Geol Lee 2, Byoung Chul Cho 3, Hye Ryun Kim 3, Kyung Hwan Kim 4
1Department of Radiation Oncology, Cha University Ilsan Cha Hospital, Cha University School of Medicine, 1205, Jungang-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10414, Republic of Korea; Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: yang816@chamc.co.kr.
2Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
3Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
4Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: KYUNGHKIM@yuhs.ac.