Abstract
Purpose: Lymphangiography has been a routine part of Hodgkin's disease staging over the past 3 decades and has an accepted role in assessing pelvic and paraaortic lymph node involvement, adequately staging patients as well as planning radiation fields. There is no consensus in the literature regarding the role of lymphangiography in promoting hypothyroidism in individuals with Hodgkin's disease irradiated with a mantle field. We sought to analyze the onset and rate of hypothyroidism in patients who received irradiation to the thyroid gland during treatment of Hodgkin's disease, as well as possible factors related to its development. Materials and Methods: One hundred and forty-two patients with Hodgkin's disease were treated between June 1967 and October 1993. All patients were treated with curative intent with radiation therapy utilizing a mantle field. Following exclusion of patients without available thyroid function tests, < 200 days of follow-up, or no radiation to the thyroid 104 patients were eligible for analysis. Follow-up ranged from 7-170 months (median 43 months). Sixty-seven patients had a lymphangiogram. 73 patients were treated with radiation alone and 31 patients with radiation therapy plus chemotherapy. All patients were treated with continuous course, once daily external beam radiotherapy using megavoltage equipment. The median
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Citation Formats
Bonin, Steven R, Fein, Douglas A, Hanlon, Alexandria L, Corn, Benjamin W, Curran, Walter J, and Coia, Lawrence R.
The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin's disease.
United States: N. p.,
1995.
Web.
doi:10.1016/0360-3016(95)97810-N.
Bonin, Steven R, Fein, Douglas A, Hanlon, Alexandria L, Corn, Benjamin W, Curran, Walter J, & Coia, Lawrence R.
The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin's disease.
United States.
https://doi.org/10.1016/0360-3016(95)97810-N
Bonin, Steven R, Fein, Douglas A, Hanlon, Alexandria L, Corn, Benjamin W, Curran, Walter J, and Coia, Lawrence R.
1995.
"The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin's disease."
United States.
https://doi.org/10.1016/0360-3016(95)97810-N.
@misc{etde_20420666,
title = {The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin's disease}
author = {Bonin, Steven R, Fein, Douglas A, Hanlon, Alexandria L, Corn, Benjamin W, Curran, Walter J, and Coia, Lawrence R}
abstractNote = {Purpose: Lymphangiography has been a routine part of Hodgkin's disease staging over the past 3 decades and has an accepted role in assessing pelvic and paraaortic lymph node involvement, adequately staging patients as well as planning radiation fields. There is no consensus in the literature regarding the role of lymphangiography in promoting hypothyroidism in individuals with Hodgkin's disease irradiated with a mantle field. We sought to analyze the onset and rate of hypothyroidism in patients who received irradiation to the thyroid gland during treatment of Hodgkin's disease, as well as possible factors related to its development. Materials and Methods: One hundred and forty-two patients with Hodgkin's disease were treated between June 1967 and October 1993. All patients were treated with curative intent with radiation therapy utilizing a mantle field. Following exclusion of patients without available thyroid function tests, < 200 days of follow-up, or no radiation to the thyroid 104 patients were eligible for analysis. Follow-up ranged from 7-170 months (median 43 months). Sixty-seven patients had a lymphangiogram. 73 patients were treated with radiation alone and 31 patients with radiation therapy plus chemotherapy. All patients were treated with continuous course, once daily external beam radiotherapy using megavoltage equipment. The median external beam dose to the mantle field was 39.6 Gy while the median dose to the thyroid was 41.5 Gy. Multivariate analysis was used to determine factors affecting hypothyroidism. Results: The actuarial 2-, and 5-year rates of biochemical hypothyroidism for all 104 patients were 18% and 37%, respectively. 40 patients developed hypothyroidism: 9 (23%) at {<=} 1 year, 18 (45%) at {<=} 2 years and 33 (83%) at {<=} 5 years. 35 patients developed chemical hypothyroidism and 5 patients developed both clinical and chemical hypothyroidism. The actuarial 2-, and 5-year rates of biochemical hypothyroidism for patients who underwent a lymphangiogram were 23% and 42%, respectively compared to 9% and 28%, respectively for patients who received mantle irradiation without a lymphangiogram (P = 0.05). Thirty-one of 67 patients (46%) who underwent lymphangiography developed biochemical hypothyroidism compared to 9 of 37 patients (24%) who did not undergo lymphangiography (P = 0.03). The median time to hypothyroidism was 25 months for patients who had a lymphangiogram compared to 40 months for patients who did not have a lymphangiogram. The effects of lymphangiogram, total thyroid dose, stage, chemotherapy, dose per fraction, energy, and age were evaluated for all patients by Cox proportional hazards regression analysis. The use of a lymphangiogram (P = 0.05) was the only variable that significantly influenced hypothyroidism. Conclusion: This is the first paper to demonstrate in a time-adjusted multivariate analysis accounting for other potentially important variables the significant effect of lymphangiography and subsequent radiation therapy on the development of hypothyroidism. This information must be balanced with the fact that lymphangiograms remain a useful aid in assessing lymph node involvement, staging patients, and planning treatment fields.}
doi = {10.1016/0360-3016(95)97810-N}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}
title = {The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin's disease}
author = {Bonin, Steven R, Fein, Douglas A, Hanlon, Alexandria L, Corn, Benjamin W, Curran, Walter J, and Coia, Lawrence R}
abstractNote = {Purpose: Lymphangiography has been a routine part of Hodgkin's disease staging over the past 3 decades and has an accepted role in assessing pelvic and paraaortic lymph node involvement, adequately staging patients as well as planning radiation fields. There is no consensus in the literature regarding the role of lymphangiography in promoting hypothyroidism in individuals with Hodgkin's disease irradiated with a mantle field. We sought to analyze the onset and rate of hypothyroidism in patients who received irradiation to the thyroid gland during treatment of Hodgkin's disease, as well as possible factors related to its development. Materials and Methods: One hundred and forty-two patients with Hodgkin's disease were treated between June 1967 and October 1993. All patients were treated with curative intent with radiation therapy utilizing a mantle field. Following exclusion of patients without available thyroid function tests, < 200 days of follow-up, or no radiation to the thyroid 104 patients were eligible for analysis. Follow-up ranged from 7-170 months (median 43 months). Sixty-seven patients had a lymphangiogram. 73 patients were treated with radiation alone and 31 patients with radiation therapy plus chemotherapy. All patients were treated with continuous course, once daily external beam radiotherapy using megavoltage equipment. The median external beam dose to the mantle field was 39.6 Gy while the median dose to the thyroid was 41.5 Gy. Multivariate analysis was used to determine factors affecting hypothyroidism. Results: The actuarial 2-, and 5-year rates of biochemical hypothyroidism for all 104 patients were 18% and 37%, respectively. 40 patients developed hypothyroidism: 9 (23%) at {<=} 1 year, 18 (45%) at {<=} 2 years and 33 (83%) at {<=} 5 years. 35 patients developed chemical hypothyroidism and 5 patients developed both clinical and chemical hypothyroidism. The actuarial 2-, and 5-year rates of biochemical hypothyroidism for patients who underwent a lymphangiogram were 23% and 42%, respectively compared to 9% and 28%, respectively for patients who received mantle irradiation without a lymphangiogram (P = 0.05). Thirty-one of 67 patients (46%) who underwent lymphangiography developed biochemical hypothyroidism compared to 9 of 37 patients (24%) who did not undergo lymphangiography (P = 0.03). The median time to hypothyroidism was 25 months for patients who had a lymphangiogram compared to 40 months for patients who did not have a lymphangiogram. The effects of lymphangiogram, total thyroid dose, stage, chemotherapy, dose per fraction, energy, and age were evaluated for all patients by Cox proportional hazards regression analysis. The use of a lymphangiogram (P = 0.05) was the only variable that significantly influenced hypothyroidism. Conclusion: This is the first paper to demonstrate in a time-adjusted multivariate analysis accounting for other potentially important variables the significant effect of lymphangiography and subsequent radiation therapy on the development of hypothyroidism. This information must be balanced with the fact that lymphangiograms remain a useful aid in assessing lymph node involvement, staging patients, and planning treatment fields.}
doi = {10.1016/0360-3016(95)97810-N}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}