Anni Young Lundgaard1, Lisa Lyngsie Hjalgrim2, Laura Ann Rechner3, Michael Lundemann3, N Patrik Brodin4, Morten Joergensen3, Lena Specht3, Maja Vestmoe Maraldo3. 1. Department of Oncology, Rigshospitalet, Unversity of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. anni.young.lundgaard@regionh.dk. 2. Department of Pediatric Haematology and Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. 3. Department of Oncology, Rigshospitalet, Unversity of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. 4. Institute for Onco-Physics, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue Bronx, 10461, NY, USA.
Abstract
PURPOSE: Adolescent young adults (AYA) with Hodgkin lymphoma (HL) are treated according to either pediatric or adult protocols, however, the best strategy has yet to be established. We describe the AYA patients referred for radiotherapy and quantify the risk of radiation-induced late effects and the corresponding life years lost (LYL) following pediatric and adult regimens. METHODS: Patients ≤24 years irradiated for HL were included. For each patient, organs at risk (OARs) were contoured and dosimetric parameters were extracted. Estimated excess hazard ratios of radiation-induced late effects were calculated from dose-response models and LYL attributable to various late effects were estimated. RESULTS: In total, 77 patients were analyzed (pediatric regimen: 15; adult regimen: 62). Age, clinical stage, and the number of patients enrolled in protocols were significantly different between the groups. Pediatric patients had more advanced disease, which resulted in larger target volumes and higher doses to most OARs, despite a lower prescribed dose compared to adult regimens. LYL estimates were all higher with the pediatric regimens. Total LYL with pediatric and adult treatment regimens were 3.2 years and 2.3 years, respectively. Due to the clinical stage variation and heterogeneity in disease location, a direct comparison of the estimated risks of late effects was only exploratory. CONCLUSION: Pediatric regimens selected patients with more advanced disease to radiotherapy resulting in larger target volumes and higher doses to the OARs. Target volume rather than prescribed dose impacted OAR exposure. Consequently, the estimated risk of radiation-induced late effects and corresponding LYL was increased when compared to adult regimens.
PURPOSE: Adolescent young adults (AYA) with Hodgkin lymphoma (HL) are treated according to either pediatric or adult protocols, however, the best strategy has yet to be established. We describe the AYA patients referred for radiotherapy and quantify the risk of radiation-induced late effects and the corresponding life years lost (LYL) following pediatric and adult regimens. METHODS:Patients ≤24 years irradiated for HL were included. For each patient, organs at risk (OARs) were contoured and dosimetric parameters were extracted. Estimated excess hazard ratios of radiation-induced late effects were calculated from dose-response models and LYL attributable to various late effects were estimated. RESULTS: In total, 77 patients were analyzed (pediatric regimen: 15; adult regimen: 62). Age, clinical stage, and the number of patients enrolled in protocols were significantly different between the groups. Pediatric patients had more advanced disease, which resulted in larger target volumes and higher doses to most OARs, despite a lower prescribed dose compared to adult regimens. LYL estimates were all higher with the pediatric regimens. Total LYL with pediatric and adult treatment regimens were 3.2 years and 2.3 years, respectively. Due to the clinical stage variation and heterogeneity in disease location, a direct comparison of the estimated risks of late effects was only exploratory. CONCLUSION: Pediatric regimens selected patients with more advanced disease to radiotherapy resulting in larger target volumes and higher doses to the OARs. Target volume rather than prescribed dose impacted OAR exposure. Consequently, the estimated risk of radiation-induced late effects and corresponding LYL was increased when compared to adult regimens.
Authors: Andreas Engert; Annette Plütschow; Hans Theodor Eich; Andreas Lohri; Bernd Dörken; Peter Borchmann; Bernhard Berger; Richard Greil; Kay C Willborn; Martin Wilhelm; Jürgen Debus; Michael J Eble; Martin Sökler; Antony Ho; Andreas Rank; Arnold Ganser; Lorenz Trümper; Carsten Bokemeyer; Hartmut Kirchner; Jörg Schubert; Zdenek Král; Michael Fuchs; Hans-Konrad Müller-Hermelink; Rolf-Peter Müller; Volker Diehl Journal: N Engl J Med Date: 2010-08-12 Impact factor: 91.245
Authors: Michael Schaapveld; Berthe M P Aleman; Anna M van Eggermond; Cécile P M Janus; Augustinus D G Krol; Richard W M van der Maazen; Judith Roesink; John M M Raemaekers; Jan Paul de Boer; Josée M Zijlstra; Gustaaf W van Imhoff; Eefke J Petersen; Philip M P Poortmans; Max Beijert; Marnix L Lybeert; Ina Mulder; Otto Visser; Marieke W J Louwman; Inge M Krul; Pieternella J Lugtenburg; Flora E van Leeuwen Journal: N Engl J Med Date: 2015-12-24 Impact factor: 91.245
Authors: Sharon M Castellino; Ann M Geiger; Ann C Mertens; Wendy M Leisenring; Janet A Tooze; Pam Goodman; Marilyn Stovall; Leslie L Robison; Melissa M Hudson Journal: Blood Date: 2010-10-29 Impact factor: 22.113
Authors: Lena Specht; Joachim Yahalom; Tim Illidge; Anne Kiil Berthelsen; Louis S Constine; Hans Theodor Eich; Theodore Girinsky; Richard T Hoppe; Peter Mauch; N George Mikhaeel; Andrea Ng Journal: Int J Radiat Oncol Biol Phys Date: 2013-06-18 Impact factor: 7.038
Authors: Marc P E André; Théodore Girinsky; Massimo Federico; Oumédaly Reman; Catherine Fortpied; Manuel Gotti; Olivier Casasnovas; Pauline Brice; Richard van der Maazen; Alessandro Re; Véronique Edeline; Christophe Fermé; Gustaaf van Imhoff; Francesco Merli; Réda Bouabdallah; Catherine Sebban; Lena Specht; Aspasia Stamatoullas; Richard Delarue; Valeria Fiaccadori; Monica Bellei; Tiana Raveloarivahy; Annibale Versari; Martin Hutchings; Michel Meignan; John Raemaekers Journal: J Clin Oncol Date: 2017-03-14 Impact factor: 44.544
Authors: Andreas Engert; Heinz Haverkamp; Carsten Kobe; Jana Markova; Christoph Renner; Antony Ho; Josée Zijlstra; Zdenek Král; Michael Fuchs; Michael Hallek; Lothar Kanz; Hartmut Döhner; Bernd Dörken; Nicole Engel; Max Topp; Susanne Klutmann; Holger Amthauer; Andreas Bockisch; Regine Kluge; Clemens Kratochwil; Otmar Schober; Richard Greil; Reinhard Andreesen; Michael Kneba; Michael Pfreundschuh; Harald Stein; Hans Theodor Eich; Rolf-Peter Müller; Markus Dietlein; Peter Borchmann; Volker Diehl Journal: Lancet Date: 2012-04-04 Impact factor: 79.321
Authors: Hans Theodor Eich; Volker Diehl; Helen Görgen; Thomas Pabst; Jana Markova; Jürgen Debus; Anthony Ho; Bernd Dörken; Andreas Rank; Anca-Ligia Grosu; Thomas Wiegel; Johann Hinrich Karstens; Richard Greil; Normann Willich; Heinz Schmidberger; Hartmut Döhner; Peter Borchmann; Hans-Konrad Müller-Hermelink; Rolf-Peter Müller; Andreas Engert Journal: J Clin Oncol Date: 2010-08-16 Impact factor: 44.544
Authors: Berthe M P Aleman; Alexandra W van den Belt-Dusebout; Willem J Klokman; Mars B Van't Veer; Harry Bartelink; Flora E van Leeuwen Journal: J Clin Oncol Date: 2003-07-28 Impact factor: 44.544
Authors: Wolfgang Dörffel; Ursula Rühl; Heike Lüders; Alexander Claviez; Marion Albrecht; Jos Bökkerink; Harald Holte; Jonas Karlen; Georg Mann; Heinz Marciniak; Felix Niggli; Kjeld Schmiegelow; Ernst-Wilhelm Schwarze; Richard Pötter; Lutz Wickmann; Günther Schellong Journal: J Clin Oncol Date: 2013-03-18 Impact factor: 44.544
Authors: Nickhill Bhakta; Qi Liu; Frederick Yeo; Malek Baassiri; Matthew J Ehrhardt; Deo K Srivastava; Monika L Metzger; Matthew J Krasin; Kirsten K Ness; Melissa M Hudson; Yutaka Yasui; Leslie L Robison Journal: Lancet Oncol Date: 2016-07-25 Impact factor: 41.316