Hormonal dysfunction is frequent in cancer survivors treated with radiotherapy to the head and neck region
Cancer treatment may lead to hormonal dysfunction. Therefore, we assessed the prevalence of dysfunction in four hormonal axes among long-term cancer survivors who received radiotherapy to the head and neck region and analyzed associations between hormonal status and clinical variables.
We included 140 cancer survivors who received radiotherapy to the head and neck region, either locally or through total body irradiation after a diagnosis of lymphoma, plasmacytoma/multiple myeloma, or carcinoma of the epipharynx. Radiation doses to the pituitary gland and thyroid gland were estimated, and blood samples were collected to analyze hormonal levels.
At a median of 16 years after their cancer diagnosis, 46 % of cancer survivors showed dysfunction in one hormonal axis, 24 % had dysfunction in two axes, and 3 % had dysfunction in three axes. Twenty cancer survivors (14 %) had hormone levels consistent with pituitary dysfunction. Cancer survivors who had received an estimated 30 Gray (Gy) or more to the pituitary gland had an increased risk for pituitary dysfunction in one of the hormonal axes (odds ratio [OR] 3.16, confidence interval [CI] 1.02–9.87, p = 0.047) and for growth hormone dysfunction alone (OR 2.96, CI 1.02–8.55, p = 0.045).
Abnormal hormone values are frequent after radiotherapy to the head and neck region.
Implications for Cancer Survivors
Screening for hormonal dysfunction during follow-up might be indicated.
KeywordsHormonal dysfunction Radiotherapy Cancer Late effects
We would like to thank the cancer survivors who participated in the survey. We would also like to thank Jan F. Evensen, Division of Surgery and Cancer Medicine, OUS, for help with provision of study patients; Are H. Pripp, Unit of Biostatistics and Epidemiology, OUS, for help with data analysis; Karsten Eilertsen, Department of Physics, Division of Surgery and Cancer Medicine, OUS, for help with the estimation of radiation doses; Olav I. Håskjold, Department of Radiology and Nuclear Medicine, OUS, for help with creating a template for the average position of the thyroid gland on X-ray images; and Kirsten A. Larsen, National Advisory Unit on Late Effects after Cancer Treatment, OUS, for practical assistance. This project has been financed with the aid of the Norwegian Cancer Society.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients included in this study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 14.Darzy KH, Shalet SM. Hypopituitarism following radiotherapy revisited. In: Wallace WBN, Kelnar CJH, editors. Endocrinopathy after childhood cancer treatment. Endocr Dev Basel, Karger. 2009;15:1-24.Google Scholar
- 28.Ho KK. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007;157(6):695–700.CrossRefPubMedGoogle Scholar
- 30.Bhatti P, Veiga LH, Ronckers CM, Sigurdson AJ, Stovall M, Smith SA, et al. Risk of second primary thyroid cancer after radiotherapy for a childhood cancer in a large cohort study: an update from the childhood cancer survivor study. Radiat Res. 2010;174(6):741–52.PubMedCentralCrossRefPubMedGoogle Scholar