January - March 2024, Volume 20, Issue 1

Gade VK, Bahl A, Rastogi A, Oinam AS, Panda NK, Ghoshal S

Dosimetric and Early Clinical Outcomes of Thyroid-Sparing Volumetric Modulated Arc Radiotherapy in Locally Advanced Head and Neck Cancers

Acta Endo (Buc) 2024, 20 (1): 59-64
doi: 10.4183/aeb.2024.59

Introduction. Radiation-induced hypothyroidism is a well-recognized entity that occurs after an interval of 15- 21 months. However, in the treatment of locally advanced Head and neck Squamous cell carcinoma (HNSCC), thyroidsparing techniques are infrequently employed. Aims. To evaluate the dosimetric and early clinical outcomes of thyroid-sparing SIB-VMAT technique (Simultaneous Integrated Boost - Volumetric Modulated Arc Radiotherapy) in patients of locally advanced HNSCC. Methods. In this two-arm prospective pilot study, patients in the study group received radiotherapy by SIBVMAT technique with a thyroid constraint to a dose of 70 Gy to the gross disease and 59.4 Gy to nodal and subclinical disease in 33 fractions over 6 ½ weeks with concurrent cisplatin. V50Gy<75% was the thyroid constraint used. The control group was treated with the same dose and technique but without using a thyroid gland constraint. The dosevolume parameters of the thyroid gland, PTV (Planning Target Volume) along with thyroid profile were analyzed. Results. Twenty-six patients were recruited. Thyroid V50Gy of the study group (65.33 ±6.63 %) was significantly lower than that of control group (80.35 ±13.40 %) (p=0.003). Tumor dose parameters of both groups were compared and revealed no significant difference. At 18 months follow-up, the incidence of any degree of hypothyroidism was 46.15% in the study group and 23.07% in the control group (p=0.216) Conclusion. In locally advanced HNSCC, it is feasible to spare the thyroid gland without compromising the tumour coverage. This has the potential to reduce the frequency of radiation-induced hypothyroidism.

Keywords: VMAT, Thyroid-sparing, Head and neck cancer.

Correspondence: Amit Bahl MD, Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, E-mail: dramitbahl@yahoo.com