Secondary Adrenal Insufficiency: A Cross-sectional Study of Nasopharyngeal Carcinoma Patients after Treatment with Intensity-modulated Radiotherapy
DCW Chan, CY Lui, KT Yuen, CH Kwok, KW Chan, ACK Cheng
Hong Kong J Radiol 2018;21:99-106
DOI: 10.12809/hkjr1816827
Objective: To review the incidence of secondary adrenal insufficiency (SAI) in nasopharyngeal carcinoma (NPC)
patients treated with intensity-modulated radiotherapy (IMRT), and to determine the characteristics and risk factors associated with the development of SAI.
Methods: A total of 143 NPC patients diagnosed between 2009 and 2010 and treated with radical IMRT were retrospectively reviewed. The low-dose short Synacthen test was used to determine the presence of SAI. Using Kaplan-Meier method and Cox proportional hazard regression, the relationship between development of SAI and various clinical parameters was evaluated.
Results: The median follow-up period was 65 months. The median mean and median maximum doses to the pituitary gland were 56.3 Gy (range, 19.1-72.0 Gy) and 59.5 Gy (range, 28.5-73.8 Gy), respectively. The cumulative incidences of SAI at 2 and 5 years post-treatment were 7.7% and 17.5%, respectively. The median time to onset of SAI was 30.5 (range, 16-82) months after radiotherapy. Multiple Cox regression analysis revealed that
receiving additional radiotherapy after a definitive course of radiotherapy was an independent risk factor for the development of SAI, with a relative risk of 6.598 (95% confidence interval = 1.554-28.013; p = 0.01).
Conclusion: SAI is common in NPC patients treated with IMRT. Regular monitoring of hypothalamic-pituitary–adrenal axis hormone function should start as early as 6 months to 1 year post-treatment so that treatment can be initiated early if indicated, especially in patients who have received additional radiotherapy after definitive radiotherapy for NPC.
Author affiliation(s):
DCW Chan, CY Lui, KT Yuen, CH Kwok, ACK Cheng: Department of Oncology, Princess Margaret Hospital, Laichikok, Hong Kong
KW Chan: Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong
中文摘要
繼發性腎上腺功能不全：鼻咽癌患者調強放射治療後的橫斷面研究
陳俊尹、呂卓如、袁錦堂、郭子熹、陳健華、鄭志堅
目的：回顧調強放療（IMRT）治療鼻咽癌患者繼發性腎上腺皮質功能不全（SAI）的發生率，確定與SAI發生相關的特徵和危險因素。
方法：回顧分析2009年至2010年間根治性IMRT治療的143例鼻咽癌患者的臨床資料。使用低劑量短Synacthen測試來確定SAI的存在。使用Kaplan-Meier方法和Cox比例風險回歸評估SAI發展與各種臨床參數之間的關係。
結果：中位隨訪時間為65個月。垂體腺平均最大劑量和中位數最大劑量分別為56.3 Gy（範圍19.1-72.0 Gy）和59.5 Gy（範圍28.5-73.8 Gy）。治療後2年和5年SAI發生率分別為7.7%和17.5%。放療至腎上腺功能不全出現的中位時間為30.5（範圍，16-82）個月。多變量分析顯示，在放療結束後接受額外放療是發生SAI的獨立危險因素，相對風險為6.598（95%置信區間 = 1.554-28.013；p = 0.01）。
結論：SAI在調強放射治療的鼻咽癌患者中很常見。對於下丘腦－垂體－腎上腺軸激素功能的定期監測應該在治療後6個月至1年內開始，如有需要可提前開始治療，特別是在鼻咽癌明確放療後接受額外放療的患者。