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Make a choice prof. dr. T.P. Links dr. S. Kruijff E.C. Jager H. Verbeek E. Oldehinkel

Project properties

Title	Evaluating the local side effects of radiotherapy on patients with thyroid cancer.
Keywords	radiotherapy Thyroid cancer Toxicities
Researchers	prof. dr. T.P. Links dr. S. Kruijff E.C. Jager H. Verbeek E. Oldehinkel
Type of project	Stage Wetenschap / Researchproject
Nature of the research	Cross-sectional study
Fields of study	surgery endocrinology radiotherapy

Background / introduction

Treatment of thyroid cancer is variable and depends on the histological subtype and extent of disease at diagnosis. Surgical options range from local to extensive thyroid and lymph node surgery or may consist of palliative debulking to prevent local mechanical problems. Radioactive iodine is a very effective additional therapy in patients with differentiated thyroid cancer as it eradicates residual microscopic disease by targeting follicular cells. For medullary thyroid carcinoma, deriving from the para-follicular C cells, surgery is the only curative treatment and radioactive iodine is ineffective. Treatment of anaplastic thyroid cancer – a very aggressive and non-iodine sensitive subtype – aims to minimize local problems and provide best supportive care. A limited number of thyroid cancer patients undergo locoregional radiotherapy, indicated after curative surgery to reduce the risk of recurrent disease or in a palliative setting to prevent tumor related symptoms. In general, radiotherapy can improve locoregional control, especially in microscopically irradically resected disease. However, side effects include: mucositis, dysfunction of the salivary glands, loss of taste, xerostomia and dysphagia. In thyroid cancer, data regarding late effects of local radiotherapy are limited. Throughout the years, improvements of radiotherapeutic techniques, such as intensity-modulated radiotherapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT), have allowed more treatment precision thereby reducing side effects. Proton therapy, using electrically charged particles (protons) instead of photons, is a technique which can target the tumor even more accurately and thereby further reduce the dose on healthy tissue. In the Netherlands, patients with head-neck cancer can qualify for proton therapy when the risk of side effects, especially xerostomia and dysphagia, is expected to be significantly lower than expected in comparison to regular external beam therapy. To explore the possible benefits of proton therapy in patients with thyroid cancer, more knowledge is needed about the radiation-induced side effects for thyroid cancer patients treated with conventional radiotherapy. Therefore we propose this project to evaluate the side effects of radiotherapy as reported by patients.

Research question / problem definition
To evaluate the acute and late radiation-induced side effects that occur after locoregional radiotherapy in patients with thyroid carcinoma.

Workplan

During this project, the student will focus on patients with thyroid cancer treated with radiotherapy in the past. After patient selection, the student will work on different aspects of research. The student will retrieve data on patient and treatment characteristics, as well as acute and late side effects from electronic patient files. Moreover, specific questionnaires will need to be sent to patients by the student. After data collection, analysis of the data will follow. During this project, the student will work in close collaboration with a PhD student that focuses on thyroid cancer. In addition, it is possible to participate in some of the clinical routine by taking part in multidisciplinary meetings and out-patient appointments at the involved departments.

References

- Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet. 2016;388(10061):2783-2795. doi:10.1016/S0140-6736(16)30172-6 - Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi:10.1089/thy.2015.0020 - Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610. doi:10.1089/thy.2014.0335 - Leeman JE, Romesser PB, Zhou Y, et al. Proton therapy for head and neck cancer: expanding the therapeutic window. Lancet Oncol. 2017;18(5):e254-e265. doi:10.1016/S1470-2045(17)30179-1 - Landelijk Indicatie Protocol Protonentherapie (versie 2.2.). Hoofd-hals tumoren. Landelijk Platform Protonentherapie, Landelijk Platform Radiotherapie Hoofd-halstumoren. - Groen AH, van Dijk D, Sluiter W, Links TP, Bijl HP, Plukker JTM. Postoperative external beam radiotherapy for locoregional control in iodine refractory differentiated thyroid cancer. Eur Thyroid J. 2022;11(1):e210033. Published 2022 Jan 25. doi:10.1530/ETJ-21-0033 - Groen AH, Beckham TH, Links TP, et al. Outcomes of surgery and postoperative radiation therapy in managing medullary thyroid carcinoma [published online ahead of print, 2019 Nov 16]. J Surg Oncol. 2019;10.1002/jso.25761. doi:10.1002/jso.25761