Risk of Subsequent Neoplasms in Childhood Cancer Survivors After Radiation Therapy: A PENTEC Comprehensive Review.

Autor:	Casey DL; Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: dana_casey@med.unc.edu., Vogelius IR; Department of Oncology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark., Brodin NP; Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York., Roberts KB; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut., Avanzo M; Division of Medical Physics, Centro di Riferimento Oncologico Aviano IRCCS, Aviano, Italy., Moni J; Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts., Owens C; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas., Ronckers CM; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands., Constine LS; Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, New York., Bentzen SM; Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland., Olch A; Radiation Oncology Department, University of Southern California, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2024 Jun 01; Vol. 119 (2), pp. 640-654. Date of Electronic Publication: 2023 Sep 29.
DOI:	10.1016/j.ijrobp.2023.07.025
Abstrakt:	Purpose: A Pediatric Normal Tissue Effects in the Clinic (PENTEC) analysis of published investigations of central nervous system (CNS) subsequent neoplasms (SNs), subsequent sarcomas, and subsequent lung cancers in childhood cancer survivors who received radiation therapy (RT) was performed to estimate the effect of RT dose on the risk of SNs and the modification of this risk by host and treatment factors. Methods and Materials: A systematic literature review was performed to identify data published from 1975 to 2022 on SNs after prior RT in childhood cancer survivors. After abstract review, usable quantitative and qualitative data were extracted from 83 studies for CNS SNs, 118 for subsequent sarcomas, and 10 for lung SNs with 4 additional studies (3 for CNS SNs and 1 for lung SNs) later added. The incidences of SNs, RT dose, age, sex, primary cancer diagnosis, chemotherapy exposure, and latent time from primary diagnosis to SNs were extracted to assess the factors influencing risk for SNs. The excess relative ratio (ERR) for developing SNs as a function of dose was analyzed using inverse-variance weighted linear regression, and the ERR/Gy was estimated. Excess absolute risks were also calculated. Results: The ERR/Gy for subsequent meningiomas was estimated at 0.44 (95% CI, 0.19-0.68); for malignant CNS neoplasms, 0.15 (95% CI, 0.11-0.18); for sarcomas, 0.045 (95% CI, 0.023-0.067); and for lung cancer, 0.068 (95% CI, 0.03-0.11). Younger age at time of primary diagnosis was associated with higher risk of subsequent meningioma and sarcoma, whereas no significant effect was observed for age at exposure for risk of malignant CNS neoplasm, and insufficient data were available regarding age for lung cancer. Females had a higher risk of subsequent meningioma (odds ratio, 1.46; 95% CI, 1.22-1.76; P < .0001) relative to males, whereas no statistically significant sex difference was seen in risk of malignant CNS neoplasms, sarcoma SNs, or lung SNs. There was an association between chemotherapy receipt (specifically alkylating agents and anthracyclines) and subsequent sarcoma risk, whereas there was no clear association between specific chemotherapeutic agents and risk of CNS SNs and lung SNs. Conclusions: This PENTEC systematic review shows a significant radiation dose-response relationship for CNS SNs, sarcomas, and lung SNs. Given the linear dose response, improved conformality around the target volume that limits the high dose volume might be a promising strategy for reducing the risk of SNs after RT. Other host- and treatment-related factors such as age and chemotherapy play a significant contributory role in the development of SNs and should be considered when estimating the risk of SNs after RT among childhood cancer survivors. (Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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