1
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Beijer JGM, Kok JL, Janssens GO, Streefkerk N, de Vries ACH, Slagter C, Maduro JH, Kroon PS, Grootenhuis MA, van Dulmen‐den Broeder E, Loonen JJ, Wendling M, Tissing WJE, van der Pal HJ, Louwerens M, Bel A, den Hartogh J, van der Heiden‐van der Loo M, Kremer LCM, Teepen JC, Ronckers CM. Adverse late health outcomes among children treated with 3D radiotherapy techniques: Study design of the Dutch pediatric 3D-RT study. Cancer Rep (Hoboken) 2023; 6:e1620. [PMID: 36715495 PMCID: PMC9939987 DOI: 10.1002/cnr2.1620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Adverse late health outcomes after multimodal treatment for pediatric cancer are diverse and of prime interest. Currently available evidence and survivorship care guidelines are largely based on studies addressing side-effects of two dimensional planned radiotherapy. AIMS The Dutch pediatric 3D-planned radiotherapy (3D-RT) study aims to gain insight in the long-term health outcomes among children who had radiotherapy in the 3D era. Here, we describe the study design, data-collection methods, and baseline cohort characteristics. METHODS AND RESULTS The 3D-RT study represents an expansion of the Dutch Childhood Cancer Survivor study (DCCSS) LATER cohort, including pediatric cancer patients diagnosed during 2000-2012, who survived at least 5 years after initial diagnosis and 2 years post external beam radiotherapy. Individual cancer treatment parameters were obtained from medical files. A national infrastructure for uniform collection and archival of digital radiotherapy files (Computed Tomography [CT]-scans, delineations, plan, and dose files) was established. Health outcome information, including subsequent tumors, originated from medical records at the LATER outpatient clinics, and national registry-linkage. With a median follow-up of 10.9 (interquartile range [IQR]: 7.9-14.3) years after childhood cancer diagnosis, 711 eligible survivors were identified. The most common cancer types were Hodgkin lymphoma, medulloblastoma, and nephroblastoma. Most survivors received radiotherapy directed to the head/cranium only, the craniospinal axis, or the abdominopelvic region. CONCLUSION The 3D-RT study will provide knowledge on the risk of adverse late health outcomes and radiation-associated dose-effect relationships. This information is valuable to guide follow-up care of childhood cancer survivors and to refine future treatment protocols.
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Affiliation(s)
| | - Judith L. Kok
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of Radiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Nina Streefkerk
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of Pediatric OncologyErasmus Medical CenterRotterdamThe Netherlands
| | - Cleo Slagter
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
| | - John H. Maduro
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of Radiation Oncology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Petra S. Kroon
- Department of Radiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Eline van Dulmen‐den Broeder
- Department of Pediatric Oncology/HematologyAmsterdam University Medical Center/Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jacqueline J. Loonen
- Department of HematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Markus Wendling
- Department of Radiation OncologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Wim J. E. Tissing
- Department of Pediatric Oncology, Beatrix Children's HospitalUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Marloes Louwerens
- Department of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Arjan Bel
- Department of Radiation OncologyAmsterdam University Medical Center/University of AmsterdamAmsterdamThe Netherlands
| | - Jaap den Hartogh
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Dutch Childhood Cancer Parent OrganizationNieuwegeinThe Netherlands
| | | | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of Pediatrics, Emma Children's HospitalAmsterdam University Medical Center/University of AmsterdamAmsterdamThe Netherlands
- University Medical Center Utrecht, Wilhelmina Children's HospitalUtrechtThe Netherlands
| | - Jop C. Teepen
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
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2
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Ntentas G, Darby SC, Aznar MC, Hodgson DC, Howell RM, Maraldo MV, Ahmed S, Ng A, Aleman BMP, Cutter DJ. Dose-response relationships for radiation-related heart disease: Impact of uncertainties in cardiac dose reconstruction. Radiother Oncol 2020; 153:155-162. [PMID: 32890611 DOI: 10.1016/j.radonc.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Radiation-related heart disease (RRHD) can occur many decades after thoracic radiotherapy for Hodgkin lymphoma (HL) or childhood cancer (CC). To quantify the likely risk of RRHD for patients treated today, dose-response relationships derived from patients treated in previous decades are used. Publications presenting these dose-response relationships usually include estimates of uncertainties in the risks but ignore the effect of uncertainties in the reconstructed cardiac doses. MATERIALS/METHODS We assessed the systematic and random uncertainties in the reconstructed doses for published dose-response relationships for RRHD risk in survivors of HL or CC. Using the same reconstruction methods as were used in the original publications, we reconstructed mean heart doses and, wherever possible, mean left-ventricular doses for an independent case-series of test patients. These patients had known, CT-based, cardiac doses which were compared with the reconstructed doses to estimate the magnitude of the uncertainties and their effect on the dose-response relationships. RESULTS For all five reconstruction methods the relationship between reconstructed and CT-based doses was linear. For all but the simplest reconstruction method, the dose uncertainties were moderate, the effect of the systematic uncertainty on the dose-response relationships was less than 10%, and the effects of random uncertainty were small except at the highest doses. CONCLUSIONS These results increase confidence in the published dose-response relationships for the risk of RRHD in HL and CC survivors. This may encourage doctors to use these dose-response relationships when estimating individualised risks for patients-an important aspect of personalising radiotherapy treatments today.
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Affiliation(s)
- Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, UK.
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marianne C Aznar
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Manchester Cancer Research Centre, University of Manchester, UK
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Maja V Maraldo
- Department of Clinical Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Sameera Ahmed
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Angela Ng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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3
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Taparra K, Lester SC, Harmsen WS, Petersen M, Funk RK, Blanchard MJ, Young P, Herrmann J, Hunzeker A, Schultz H, McCollough C, Tasson A, Leng S, Martenson JA, Whitaker TJ, Williamson E, Laack NN. Reducing Heart Dose with Protons and Cardiac Substructure Sparing for Mediastinal Lymphoma Treatment. Int J Part Ther 2020; 7:1-12. [PMID: 33094130 PMCID: PMC7574827 DOI: 10.14338/ijpt-20-00010.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Electrocardiogram-gated computed tomography with coronary angiography can be used for cardiac substructure sparing (CSS) optimization, which identifies and improves avoidance of cardiac substructures when treating with intensity modulated radiotherapy (IMRT). We investigated whether intensity modulated proton therapy (IMPT) would further reduce dose to cardiac substructures for patients with mediastinal lymphoma. Patients and Methods Twenty-one patients with mediastinal lymphoma were enrolled and underwent electrocardiogram-gated computed tomography angiography during or shortly after simulation for radiotherapy planning. Thirteen patients with delineated cardiac substructures underwent comparative planning with both IMPT and IMRT. Plans were normalized for equivalent (95%) target volume coverage for treatment comparison. Results Thirteen patients met criteria for this study. The median size of the mediastinal lymphadenopathy was 7.9 cm at the greatest diameter. Compared with IMRT-CSS, IMPT-CSS significantly reduced mean dose to all cardiac substructures, including 3 coronary arteries and 4 cardiac valves. Use of IMPT significantly reduced average whole-heart dose from 9.6 to 4.9 Gy (P < .0001), and average mean lung dose was 9.7 vs 5.8 Gy (P < .0001). Prospectively defined clinically meaningful improvement was observed in at least 1 coronary artery in 9 patients (69%), at least 1 cardiac valve in 10 patients (77%), and whole heart in all 13 patients. Conclusions For patients with mediastinal lymphoma, IMPT-CSS treatment planning significantly reduced radiation dose to cardiac substructures. The significant improvements outlined in this study for proton therapy suggest possible clinical improvement in alignment with previous analyses of CSS optimization.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Molly Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Ryan K Funk
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Phillip Young
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Joerg Herrmann
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Ashley Hunzeker
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heather Schultz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shuai Leng
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Eric Williamson
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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4
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Hoppe BS, Bates JE, Mendenhall NP, Morris CG, Louis D, Ho MW, Hoppe RT, Shaikh M, Li Z, Flampouri S. The Meaningless Meaning of Mean Heart Dose in Mediastinal Lymphoma in the Modern Radiation Therapy Era. Pract Radiat Oncol 2020; 10:e147-e154. [DOI: 10.1016/j.prro.2019.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/10/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
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Xu C, Guo L, Liao Z, Wang Y, Liu X, Zhao S, Wang J, Yuan Z, Wang P, Lin SH. Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy. Clin Transl Radiat Oncol 2019; 17:17-23. [PMID: 31080898 PMCID: PMC6506607 DOI: 10.1016/j.ctro.2019.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/07/2019] [Accepted: 04/13/2019] [Indexed: 12/13/2022] Open
Abstract
Dosimetric parameters for the heart and lung are associated with overall survival in esophageal cancer patients. Heart and lung doses were associated with cardiac and pulmonary complications. Patients with cardiac and pulmonary complications are strongly correlated with survival outcomes. Dosimetric relationship with clinical outcomes are predictive for surgical and non-surgical patients.
Purpose To analyze associations between heart and lung dose and overall survival (OS) in patients with esophageal cancer who received concurrent chemo-radiotherapy (CCRT) with or without surgery. Patients and methods Patients received intensity-modulated radiation therapy (median dose 50.4 Gy) from 2004 through 2016. Cutoff points for continuous variables were calculated using the method of Contal and O’Quigley. Kaplan-Meier method with log-rank tests was used to calculate survival. OS was analyzed with both univariate and multivariable Cox models. Results In all, 560 patients were analyzed; median follow-up time was 29.3 months, and 5-year OS rate was 41.7%. Heart V30 >45% and mean lung dose (MLD) >10 Gy were found to be independently associated with worse survival after adjustment for other clinical and dosimetric factors (P < 0.05). Heart and lung doses were also found to be risk factors for radiation-induced cardiac and pulmonary complications (P < 0.05): 8.5% of patients with heart V30 ≤45% had cardiac complications vs. 15% for V30 >45% (P = 0.046); 18.8% of patients with MLD ≤10 Gy had pulmonary complications vs. 27% for MLD >10 Gy (P = 0.020). Having cardiac complications was associated with worse survival (5-year OS rates 27.6% with vs. 43.2% without, P = 0.012), and having pulmonary complications was associated with worse survival as well (5-year OS rates 23.1% with vs. 47.4% without, P < 0.001). Conclusion Both heart and lung doses independently predicted worse OS in patients with esophageal cancer, even after adjustment for other clinical and dosimetric factors, and were also risk factors for radiation-induced complications. Both irradiated heart and lung doses should be minimized as a whole.
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Affiliation(s)
- Cai Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lanwei Guo
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yifan Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiyou Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, Hubei, China
| | - Shuangtao Zhao
- Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Science, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Gasic D, Rosenschöld PMA, Vogelius IR, Maraldo MV, Aznar MC, Nysom K, Björk-Eriksson T, Bentzen SM, Brodin NP. Retrospective estimation of heart and lung doses in pediatric patients treated with spinal irradiation. Radiother Oncol 2018; 128:209-213. [PMID: 29859753 PMCID: PMC6261493 DOI: 10.1016/j.radonc.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate whether treatment information from medical records can be used to estimate radiation doses to heart and lungs retrospectively in pediatric patients receiving spinal irradiation with conventional posterior fields. MATERIAL AND METHODS An algorithm for retrospective dosimetry in children treated with spinal irradiation was developed in a cohort of 21 pediatric patients with available CT-scans and treatment plans. We developed a multivariable linear regression model with explanatory variables identifiable in case note review for retrospective estimation of minimum, maximum, mean and V10%-V80% doses to the heart and lungs. Doses were estimated for both linear accelerator (Linac) and 60Co radiation therapy modalities. RESULTS Age and spinal field width were identified as statistically significant predictors of heart and lung doses in multivariable analyses (p < 0.01 in all models). Models showed excellent predictive performance with R2 = 0.70 for mean heart dose and 0.79 for mean lung dose, for Linac plans. In leave-one-out cross-validation analysis the average difference between predicted and actual mean heart dose was 6.7% and 7.6% of the prescription dose for Linac and 60Co plans, respectively, and 5.2% and 4.9% for mean lung dose. Due to the small sample size and large inter-patient variation in heart and lung dose, prospective studies validating these findings are highly warranted. CONCLUSIONS The models presented here provide retrospective estimates of heart and lung doses for historical cohorts of pediatric patients, thus facilitating studies of long-term adverse effects of radiation.
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Affiliation(s)
- Daniel Gasic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark.
| | - Per Munck Af Rosenschöld
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ivan R Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja V Maraldo
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Marianne C Aznar
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Regional Cancer Centre West, Gothenburg, Sweden
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Nils Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, USA
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7
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Russell NS, Krul IM, van Eggermond AM, Aleman BM, Cooke R, Kuiper S, Allen SD, Wallis MG, Llanas D, Diallo I, de Vathaire F, Smith SA, Hauptmann M, Broeks A, Swerdlow AJ, Van Leeuwen FE. Retrospective methods to estimate radiation dose at the site of breast cancer development after Hodgkin lymphoma radiotherapy. Clin Transl Radiat Oncol 2017; 7:20-27. [PMID: 29594225 PMCID: PMC5862668 DOI: 10.1016/j.ctro.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/16/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND An increased risk of breast cancer following radiotherapy for Hodgkin lymphoma (HL) has now been robustly established. In order to estimate the dose-response relationship more accurately, and to aid clinical decision making, a retrospective estimation of the radiation dose delivered to the site of the subsequent breast cancer is required. METHODS For 174 Dutch and 170 UK female patients with breast cancer following HL treatment, the 3-dimensional position of the breast cancer in the affected breast was determined and transferred onto a CT-based anthropomorphic phantom. Using a radiotherapy treatment planning system the dose distribution on the CT-based phantom was calculated for the 46 different radiation treatment field set-ups used in the study population. The estimated dose at the centre of the breast cancer, and a margin to reflect dose uncertainty were determined on the basis of the location of the tumour and the isodose lines from the treatment planning. We assessed inter-observer variation and for 47 patients we compared the results with a previously applied dosimetry method. RESULTS The estimated median point dose at the centre of the breast cancer location was 29.75 Gy (IQR 5.8-37.2), or about 75% of the prescribed radiotherapy dose. The median dose uncertainty range was 5.97 Gy. We observed an excellent inter-observer variation (ICC 0.89 (95% CI: 0.74-0.95)). The absolute agreement intra-class correlation coefficient (ICC) for inter-method variation was 0.59 (95% CI: 0.37-0.75), indicating (nearly) good agreement. There were no systematic differences in the dose estimates between observers or methods. CONCLUSION Estimates of the dose at the point of a subsequent breast cancer show good correlation between methods, but the retrospective nature of the estimates means that there is always some uncertainty to be accounted for.
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Affiliation(s)
- Nicola S. Russell
- Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Inge M. Krul
- Divison of Psychosocial Research, Epidemiology and Biostatistics, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Anna M. van Eggermond
- Divison of Psychosocial Research, Epidemiology and Biostatistics, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Berthe M.P. Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Rosie Cooke
- Division of Genetics and Epidemiology (R.C., A.J.S.), Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Susanne Kuiper
- Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Steven D. Allen
- Department of Radiology, Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, UK
| | - Matthew G. Wallis
- Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, England, UK
| | - Damien Llanas
- Cancer and Radiation Team, Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale Unit 1018, Villejuif, France
| | - Ibrahima Diallo
- Cancer and Radiation Team, Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale Unit 1018, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale Unit 1018, Villejuif, France
| | - Susan A. Smith
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Michael Hauptmann
- Divison of Psychosocial Research, Epidemiology and Biostatistics, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Annegien Broeks
- Division of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Anthony J. Swerdlow
- Division of Genetics and Epidemiology (R.C., A.J.S.), Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
- Division of Breast Cancer Research (A.J.S.), Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - Flora E. Van Leeuwen
- Divison of Psychosocial Research, Epidemiology and Biostatistics, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
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8
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Wollschläger D, Karle H, Stockinger M, Bartkowiak D, Bührdel S, Merzenich H, Wiegel T, Schmidberger H, Blettner M. Predicting Heart Dose in Breast Cancer Patients Who Received 3D Conformal Radiation Therapy. HEALTH PHYSICS 2017; 112:1-10. [PMID: 27906782 DOI: 10.1097/hp.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiac late effects are a major health concern for long-term survivors after radiotherapy for breast cancer. Large cohort studies to better understand the exact dose-response relationship require individual estimates of radiation dose to the heart. To predict individual cardiac dose from information that is typically available for all members of a retrospective epidemiological cohort study, 774 female breast cancer patients treated with megavoltage tangential field radiotherapy in 1998-2008 were examined. All dose distributions were calculated using Eclipse with the anisotropic analytical algorithm (AAA) for photon fields and the electron Monte Carlo algorithm for electron boost fields. Based on individual dose volume histograms, the authors calculated absorbed dose in the complete heart as well as in six functional substructures. Statistical models were developed to predict absorbed dose using only covariate information from patients' clinical records on tumor location, patient anatomy and radiotherapy prescription. The out-of-sample prediction error for mean heart dose was 54% (coefficient of variation). The prediction error in functional substructures ranged from 49-68% for mean dose and from 52-86% for extreme dose. The authors conclude that based on a patient sample with exact heart dosimetry, it is possible to use clinical information alone to predict absorbed heart dose in the remaining cohort with a quantified error suitable for dose-response analyses of cardiac late effects.
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Affiliation(s)
- Daniel Wollschläger
- *Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany; †Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany; ‡Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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9
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van Nimwegen FA, Cutter DJ, Schaapveld M, Darby SC, Aleman BMP, van Leeuwen FE. Reply to D. Vordermark and T. Pelz and R. Mazzola et al. J Clin Oncol 2016; 34:2941-2. [PMID: 27138579 DOI: 10.1200/jco.2016.67.4358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
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10
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Vordermark D, Pelz T. Coronary Heart Disease After Mediastinal Radiotherapy for Hodgkin Lymphoma: Can Risk Calculations From Historic Cohorts Be Used Today? J Clin Oncol 2016; 34:2939-40. [DOI: 10.1200/jco.2015.65.8286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Tanja Pelz
- Martin Luther University Halle-Wittenberg, Halle, Germany
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11
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Maraldo MV, Ng AK. Minimizing Cardiac Risks With Contemporary Radiation Therapy for Hodgkin Lymphoma. J Clin Oncol 2016; 34:208-10. [DOI: 10.1200/jco.2015.64.6588] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Andrea K. Ng
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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12
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van Nimwegen FA, Schaapveld M, Cutter DJ, Janus CP, Krol AD, Hauptmann M, Kooijman K, Roesink J, van der Maazen R, Darby SC, Aleman BM, van Leeuwen FE. Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma. J Clin Oncol 2016; 34:235-43. [DOI: 10.1200/jco.2015.63.4444] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose Cardiovascular diseases are increasingly recognized as late effects of Hodgkin lymphoma (HL) treatment. The purpose of this study was to identify the risk factors for coronary heart disease (CHD) and to quantify the effects of radiation dose to the heart, chemotherapy, and other cardiovascular risk factors. Patients and Methods We conducted a nested case-control study in a cohort of 2,617 5-year HL survivors, treated between 1965 and 1995. Cases were patients diagnosed with CHD as their first cardiovascular event after HL. Detailed treatment information was collected from medical records of 325 cases and 1,204 matched controls. Radiation charts and simulation radiographs were used to estimate in-field heart volume and mean heart dose (MHD). A risk factor questionnaire was sent to patients still alive. Results The median interval between HL and CHD was 19.0 years. Risk of CHD increased linearly with increasing MHD (excess relative risk [ERR]) per Gray, 7.4%; 95% CI, 3.3% to 14.8%). This results in a 2.5-fold increased risk of CHD for patients receiving a MHD of 20 Gy from mediastinal radiotherapy, compared with patients not treated with mediastinal radiotherapy. ERRs seemed to decrease with each tertile of age at treatment (ERR/Gy<27.5years, 20.0%; ERR/Gy27.5-36.4years, 8.8%; ERR/Gy36.5-50.9years, 4.2%; Pinteraction = .149). Having ≥ 1 classic CHD risk factor (diabetes mellitus, hypertension, or hypercholesterolemia) independently increased CHD risk (rate ratio, 1.5; 95% CI, 1.1 to 2.1). A high level of physical activity was associated with decreased CHD risk (rate ratio, 0.5; 95% CI, 0.3 to 0.8). Conclusion The linear radiation dose-response relationship identified can be used to predict CHD risk for future HL patients and survivors. Appropriate early management of CHD risk factors and stimulation of physical activity may reduce CHD risk in HL survivors.
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Affiliation(s)
- Frederika A. van Nimwegen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Michael Schaapveld
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - David J. Cutter
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Cècile P.M. Janus
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Augustinus D.G. Krol
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Michael Hauptmann
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Karen Kooijman
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Judith Roesink
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Richard van der Maazen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Sarah C. Darby
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Berthe M.P. Aleman
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Flora E. van Leeuwen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
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