Radiation Dose-Volume-Response Relationships for Adverse Events in Childhood Cancer Survivors: Introduction to the Scientific Issues in PENTEC.

Autor:	Bentzen SM; Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: sbentzen@som.umaryland.edu., Vogelius IR; Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark., Hodgson D; Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada., Howell R; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas., Jackson A; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York., Hua CH; Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee., Olch AJ; Department of Radiation Oncology, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California., Ronckers C; Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany., Kremer L; Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands., Milano M; Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, New York., Marks LB; Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina., Constine LS; Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, New York.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2024 Jun 01; Vol. 119 (2), pp. 338-353.
DOI:	10.1016/j.ijrobp.2023.11.028
Abstrakt:	At its very core, radiation oncology involves a trade-off between the benefits and risks of exposing tumors and normal tissue to relatively high doses of ionizing radiation. This trade-off is particularly critical in childhood cancer survivors (CCS), in whom both benefits and risks can be hugely consequential due to the long life expectancy if the primary cancer is controlled. Estimating the normal tissue-related risks of a specific radiation therapy plan in an individual patient relies on predictive mathematical modeling of empirical data on adverse events. The Pediatric Normal-Tissue Effects in the Clinic (PENTEC) collaborative network was formed to summarize and, when possible, to synthesize dose-volume-response relationships for a range of adverse events incident in CCS based on the literature. Normal-tissue clinical radiation biology in children is particularly challenging for many reasons: (1) Childhood malignancies are relatively uncommon-constituting approximately 1% of new incident cancers in the United States-and biologically heterogeneous, leading to many small series in the literature and large variability within and between series. This creates challenges in synthesizing data across series. (2) CCS are at an elevated risk for a range of adverse health events that are not specific to radiation therapy. Thus, excess relative or absolute risk compared with a reference population becomes the appropriate metric. (3) Various study designs and quantities to express risk are found in the literature, and these are summarized. (4) Adverse effects in CCS often occur 30, 50, or more years after therapy. This limits the information content of series with even very extended follow-up, and lifetime risk estimates are typically extrapolations that become dependent on the mathematical model used. (5) The long latent period means that retrospective dosimetry is required, as individual computed tomography-based radiation therapy plans gradually became available after 1980. (6) Many individual patient-level factors affect outcomes, including age at exposure, attained age, lifestyle exposures, health behaviors, other treatment modalities, dose, fractionation, and dose distribution. (7) Prospective databases with individual patient-level data and radiation dosimetry are being built and will facilitate advances in dose-volume-response modeling. We discuss these challenges and attempts to overcome them in the setting of PENTEC. (Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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