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Évaluation de la fonction thyroïdienne et de l’hypothyroïdie après une radiothérapie postopératoire chez les patientes atteintes d’un cancer du sein
Abstract
Contexte : Les progrès réalisés en radiothérapie ont amélioré le sort des patientes atteintes de cancer du sein. Malgré ses avantages thérapeutiques, la radiothérapie a des effets toxiques iatrogènes et des répercussions sur les survivantes du cancer du sein qui font toujours l’objet de débats, et qui méritent qu’on s’y attarde. La présente étude vise à évaluer les taux d’hypothyroïdie infraclinique et d’hypoparathyroïdie chez les patientes atteintes de cancer du sein ayant reçu de la radiothérapie.
Méthodologie : Pour l’étude, de type transversal, on a recruté 70 femmes sous radiothérapie pour traiter un cancer du sein. La fonction thyroïdienne a été évaluée par un examen de laboratoire mesurant les taux de thyréostimuline (TSH), de thyroxine libre (T4) et de triiodothyronine libre (T3). La fonction parathyroïdienne a été évaluée par mesure des taux sériques de calcium (Ca), de phosphore (P) et d’hormone parathyroïdienne (PTH) avant le traitement, puis 6 mois et 12 mois après la radiothérapie.
Résultats : L’âge moyen des patientes était de 54,3 ± 6,4 ans. Aucun cas d’hypothyroïdie n’a été décelé avant la radiothérapie. Cependant, une hypothyroïdie est apparue chez 9 patientes dans les 6 mois suivant la radiothérapie (1 cas clinique et 8 cas infracliniques, donc 13 % au total), et on a diagnostiqué une hypothyroïdie à 6 patientes dans les 12 mois après la radiothérapie (1 cas clinique et 5 cas infracliniques, donc 8,7 % au total). Des relations significatives ont été observées dans les taux d’hypothyroïdie entre les mesures prises 6 mois (p = 0,003) et 12 mois (p = 0,028) après la radiothérapie et les mesures de départ. On n’a constaté aucun cas d’hypoparathyroïdie avant ou après le traitement.
Conclusion : En résumé, on observe que le dysfonctionnement thyroïdien et parathyroïdien après la radiothérapie est relativement fréquent chez les femmes atteintes de cancer du sein. Il s’agit d’une cause de morbidité traitable. Par conséquent, un contrôle systématique de la fonction thyroïdienne est à recommander pour améliorer la qualité de vie des survivantes de cancer du sein.
Mots-clés : radiothérapie, hypothyroïdie infraclinique, cancer du sein, hypoparathyroïdie
DOI:10.5737/23688076344483
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Aboelnaga, M. M., & Aboelnaga, E. M. (2015). Early parathyroid hormone laboratory abnormalities related to therapeutic radiation of neck: An Egyptian experience. Medical Oncology, 32(5), 1–5.
Alterio, D., Jereczek-Fossa, B. A., Franchi, B., D’Onofrio, A., Piazzi, V., Rondi, E., Ciocca, M., Gibelli, B., Grosso, E., & Tradati, N. (2007). Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: A retrospective analysis of seventy-three patients. International Journal of Radiation Oncology* Biology* Physics, 67(1), 144–150.
Bassiri, R.M., & Utiger, R.D. (1974). Thyrotropin-releasing hormone in the hypothalamus of the rat. Endocrinology, 94(1), 188-197.
Beck-Peccoz, P., Amr, S., Menezes-Ferreira, M. M., Faglia, G., & Weintraub, B. D. (1985). Decreased receptor binding of biologically inactive thyrotropin in central hypothyroidism: Effect of treatment with thyrotropin-releasing hormone. New England Journal of Medicine, 312(17), 1085–1090.
Bruning, P., Bonfrer, J., Jong-Bakker, D., Nooyen, W., & Burgers, M. (1985). Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph nodes. British journal of cancer, 51(5), 659–663.
Dahbi, Z., Sbai, A., & Mezouar, L. (2018). Thyroid function after hypofractionated adjuvant radiotherapy for localized breast cancer. Cancer Radiotherapie: Journal de la Societe Francaise de Radiotherapie Oncologique, 23(1), 34–37.
Darvish, L., Ghorbani, M., Teshnizi, S. H., Roozbeh, N., Seif, F., Bayatiani, M. R., Knaup, C., & Amraee, A. (2018). Evaluation of thyroid gland as an organ at risk after breast cancer radiotherapy: A systematic review and meta-analysis. Clinical and Translational Oncology, 20(11), 1430–1438.
Emami, B., Lyman, J., Brown, A., Cola, L., Goitein, M., Munzenrider, J., Shank, B., Solin, L., & Wesson, M. (1991). Tolerance of normal tissue to therapeutic irradiation. International Journal of Radiation Oncology* Biology* Physics, 21(1), 109–122.
Fierabracci, P., Pinchera, A., Miccoli, P., Conte, P., Vignali, E., Zaccagnini, M., Marcocci, C., & Giani, C. (2001). Increased prevalence of primary hyperparathyroidism in treated breast cancer. Journal of Endocrinological Investigation, 24(5), 315–320.
Franco, P., De Felice, F., Jagsi, R., Nader Marta, G., Kaidar-Person, O., Gabrys, D., Kim, K., Ramiah, D., Meattini, I., & Poortmans, P. (2023). Breast cancer radiation therapy: A bibliometric analysis of the scientific literature. Clin Transl Radiat Oncol, 39, 100556. https://doi.org/10.1016/j.ctro.2022.11.015
Giv, M. D., Toosi, M. B., Aghamiri, S., Akbari, F., & Taeb, S. (2016). Calculation of thyroid dose with planner system and evaluation of thyroid function after radiotherapy for patients with breast cancer. Journal of Biomedical Physics & Engineering, 6(4), 220.
Haciislamoglu, E., Canyilmaz, E., Gedik, S., Aynaci, O., Serdar, L., & Yoney, A. (2019). Effect of dose constraint on the thyroid gland during locoregional intensity-modulated radiotherapy in breast cancer patients. Journal of Applied Clinical Medical Physics, 20(7), 135–141.
Hahn, W., Elenbaas, B., Stewart, S., Watnick, R., Yang, J., Mani, S., & Weinberg, R. (2001). Rules governing the creation of human tumor cells. European Journal of Cancer(37), S369.
Hancock, S. L., McDougall, I. R., & Constine, L. S. (1995). Thyroid abnormalities after therapeutic external radiation. International Journal of Radiation Oncology* Biology* Physics, 31(5), 1165–1170.
Hermann, R. M., Henkel, K., Christiansen, H., Vorwerk, H., Hille, A., Hess, C. F., & Schmidberger, H. (2005). Testicular dose and hormonal changes after radiotherapy of rectal cancer. Radiotherapy and Oncology, 75(1), 83–88.
Holten, I., & Petersen, L. (1988). Early changes in parathyroid function after high-dose irradiation of the neck. Cancer, 62(8), 1476–1478.
Huang, R., Xiang, J., & Zhou, P. (2019). Vitamin D, gut microbiota, and radiation-related resistance: A love-hate triangle. Journal of Experimental & Clinical Cancer Research, 38(1), 1–10.
Jereczek-Fossa, B. A., Alterio, D., Jassem, J., Gibelli, B., Tradati, N., & Orecchia, R. (2004). Radiotherapy-induced thyroid disorders. Cancer treatment reviews, 30(4), 369–384.
Johansen, S., Reinertsen, K., Knutstad, K., Olsen, D. R., & Fosså, S. (2011). Dose distribution in the thyroid gland following radiation therapy of breast cancer–A retrospective study. Radiation Oncology, 6(1), 1–7.
Kanyilmaz, G., Aktan, M., Koc, M., Demir, H., & Demir, L. S. (2017). Radiation-induced hypothyroidism in patients with breast cancer: A retrospective analysis of 243 cases. Medical Dosimetry, 42(3), 190–196.
Kuten, A., Lubochitski, R., Fishman, G., Dale, J., Stein, M.E. (1996). Postradiotherapy hypothyroidism: Radiation dose response and chemotherapeutic radiosensitization at less than 40 Gy. Journal of surgical oncology, 61(4), 281–283.
Laway, B., Shafi, K. M., Majid, S., Lone, M. M., Afroz, F., Khan, S., & Roohi, R. (2012). Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland. Indian Journal of Endocrinology and Metabolism, 16(Suppl 2), S329.
Loibl, S., Poortmans, P., Morrow, M., Denkert, C., & Curigliano, G. (2021). Breast cancer. Lancet, 397(10286), 1750–1769. https://doi.org/10.1016/s0140-6736(20)32381-3
?ukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., & Stanis?awek, A. (2021). Breast cancer-Epidemiology, risk factors, classification, prognostic markers, and current treatment strategies–An updated review. Cancers (Basel), 13(17). https://doi.org/10.3390/cancers13174287
Ozawa, H., Saitou, H., Mizutari, K., Takata, Y., & Ogawa, K. (2007). Hypothyroidism after radiotherapy for patients with head and neck cancer. American Journal of Otolaryngology, 28(1), 46–49.
Park, J., Kim, C., Ki, Y., Kim, W., Nam, J., Kim, D., Park, D., Jeon, H., Kim, D. W., & Joo, J. H. (2022). Incidence of hypothyroidism after treatment for breast cancer: A Korean population-based study. Plos one, 17(6), e0269893.
Pillai, U. S., Kayal, S., Cyriac, S., Nisha, Y., Dharanipragada, K., Kamalanathan, S. K., Halanaik, D., Kumar, N., Madasamy, P., & Muniswamy, D. K. (2019). Late effects of breast cancer treatment and outcome after corrective interventions. Asian Pacific Journal of Cancer Prevention: APJCP, 20(9), 2673.
Reinertsen, K. V., Cvancarova, M., Wist, E., Bjøro, T., Dahl, A. A., Danielsen, T., & Fosså, S. D. (2009). Thyroid function in women after multimodal treatment for breast cancer stage II/III: Comparison with controls from a population sample. International Journal of Radiation Oncology* Biology* Physics, 75(3), 764–770.
Rosen, I. B., Strawbridge, H. G., & Bain, J. (1975). A case of hyperparathyroidism associated with radiation to the head and neck area. Cancer, 36(3), 1111–1114.
Smith, G. L., Smith, B. D., Giordano, S. H., Shih, Y. C. T., Woodward, W. A., Strom, E. A., Perkins, G. H., Tereffe, W., Yu, T. K., & Buchholz, T. A. (2008). Risk of hypothyroidism in older breast cancer patients treated with radiation. Cancer: Interdisciplinary International Journal of the American Cancer Society, 112(6), 1371–1379.
Stephen, A. E., Chen, K. T., Milas, M., & Siperstein, A. E. (2004). The coming of age of radiation-induced hyperparathyroidism: Evolving patterns of thyroid and parathyroid disease after head and neck irradiation. Surgery, 136(6), 1143–1153.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Tamura, K., Shimaoka, K., Friedman, M. (1981). Thyroid abnormalities associated with treatment of malignant lymphoma. Cancer, 47(11), 2704–11.
Taylor, C., Correa, C., Duane, F. K., Aznar, M. C., Anderson, S. J., Bergh, J., Dodwell, D., Ewertz, M., Gray, R., & Jagsi, R. (2017). Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomized trials. Journal of Clinical Oncology, 35(15), 1641.
Tunio, M. A., Al Asiri, M., Bayoumi, Y., Stanciu, L. G., Al Johani, N., & Al Saeed, E. F. (2015). Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study. Journal of cancer research and therapeutics, 11(4), 684.
Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, S. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573–577.
Woll, M. L., Mazeh, H., Anderson, B. M., Chen, H., & Sippel, R. S. (2012). Breast radiation correlates with side of parathyroid adenoma. World journal of surgery, 36(3), 607–611.
Wolny-Rokicka, E., Tukiendorf, A., Wydma?ski, J., Roszkowska, D., Staniul, B. S., & Zembro?-?acny, A. (2016). Thyroid function after postoperative radiation therapy in patients with breast cancer. Asian Pac J Cancer Prev, 17(10), 4577–4581. https://doi.org/10.22034/apjcp.2016.17.10.4577
Yao, L., Li, J., Li, M., Lin, C., Hui, X., Tamilselvan, D., Kandi, M., Sreekanta, A., Makhdami, N., & Ali, D. S. (2022). Parathyroid hormone therapy for managing chronic hypoparathyroidism: A systematic review and meta-analysis. Journal of Bone and Mineral Research, 37(12), 2654–2662.
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