Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study
In: ISSN: 0732-183X, 2023
academicJournal
Zugriff:
International audience ; PURPOSE Radiation to the bone and exposure to alkylating agents increases the risk of bone cancer among survivors of childhood cancer, but there is uncertainty regarding the risks of bone tissue radiation doses below 10 Gy and the dose-response relationship for specific types of chemotherapy. METHODS Twelve European countries contributed 228 cases and 228 matched controls to a nested case-control study within a cohort of 69,460 5-year survivors of childhood cancer. Odds ratios (ORs) of developing bone cancer for different levels of cumulative radiation exposure and cumulative doses of specific types of chemotherapy were calculated. Excess ORs were calculated to investigate the shape and extent of any dose-response relationship. RESULTS The OR associated with bone tissue exposed to 1-4 Gy was 4.8-fold (95% CI, 1.2 to 19.6) and to 5-9 Gy was 9.6-fold (95% CI, 2.4 to 37.4) compared with unexposed bone tissue. The OR increased linearly with increasing dose of radiation ( P trend < .001) up to 78-fold (95% CI, 9.2 to 669.9) for doses of ≥40 Gy. For cumulative alkylating agent doses of 10,000-19,999 and ≥20,000 mg/m 2 , the radiation-adjusted ORs were 7.1 (95% CI, 2.2 to 22.8) and 8.3 (95% CI, 2.8 to 24.4), respectively, with independent contributions from each of procarbazine, ifosfamide, and cyclophosphamide. Other cytotoxics were not associated with bone cancer. CONCLUSION To our knowledge, we demonstrate—for the first time—that the risk of bone cancer is increased 5- to 10-fold after exposure of bone tissue to cumulative radiation doses of 1-9 Gy. Alkylating agents exceeding 10,000 mg/m 2 increase the risk 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide. These substantially elevated risks should be used to develop/update clinical follow-up guidelines and survivorship care plans.
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Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study
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Autor/in / Beteiligte Person: | Reulen, Raoul ; Winter, David ; Diallo, Ibrahim ; Veres, Cristina ; Llanas, Damien ; Allodji, Rodrigue ; Bagnasco, Francesca ; Bárdi, Edit ; Feijen, Elizabeth A.M. ; Alessi, Daniela ; Fidler-Benaoudia, Miranda ; Høgsholt, Stine ; Teepen, Jop ; Linge, Helena ; Haddy, Nadia ; Byrne, Julianne ; Debiche, Ghazi ; Grabow, Desiree ; Gudmundsdottir, Thorgerdur ; Fauchery, Romain ; Zrafi, Wael ; Michel, Gisela ; Øfstaas, Hilde ; Kaatsch, Peter ; Vu-Bezin, Giao ; Jenkinson, Helen ; Kaiser, Melanie ; Skinner, Roderick ; Cole, Trevor ; Waespe, Nicolas ; Sommer, Grit ; Nordenfelt, Susanne ; Jankovic, Momcilo ; Lähteenmäki Taalas, Tuomas ; Maule, Milena ; van der Pal, Helena J.H. ; Ronckers, Cécile ; van Leeuwen, Flora ; Kok, Judith ; Terenziani, Monica ; Winther Gunnes, Maria ; Wiebe, Thomas ; Sacerdote, Carlotta ; Jakab, Zsuzsanna ; Haupt, Riccardo ; Lähteenmäki, Päivi ; Zadravec Zaletel, Lorna ; Kuehni, Claudia ; Winther, Jeanette ; Kremer, Leontien C.M. ; Hjorth, Lars ; de Vathaire, Florent ; Hawkins, Michael ; University of Birmingham Birmingham ; Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay ; Institut Gustave Roussy (IGR) ; IRCCS Istituto Giannina Gaslini Genoa, Italy ; University of Linz - Johannes Kepler Universität Linz (JKU) ; Kepler University Hospital ; General Hospital Linz ; Princess Máxima Center for Pediatric Oncology ; Università degli studi di Torino = University of Turin (UNITO) ; Città della Salute e della Scienza di Torino (A.O.U) ; University of Calgary ; University, Lund ; Skane University Hospital Lund ; Boyne Research Institute Drogheda, Irlande (BRI) ; Johannes Gutenberg - Universität Mainz = Johannes Gutenberg University (JGU) ; Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI) ; Landspitali National University Hospital of Iceland ; Université de Lucerne = Universität Luzern (UNILU) ; Cancer Registry of Norway ; University Medical Center Mainz ; Birmingham Children’s Hospital ; Newcastle Upon Tyne Hospitals NHS Foundation Trust ; Great North Children’s Hospital Newcastle Upon Tyne, UK ; Newcastle University Newcastle ; Birmingham Women's and Children's NHS Foundation Trust ; Bern University Hospital Berne (Inselspital) ; Universität Bern / University of Bern (UNIBE) ; Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB) ; San Gerardo Hospital Monza, Italy (SGH) ; Turku University Hospital (TYKS) ; University of Turku ; Netherlands Cancer Institute (NKI) ; Antoni van Leeuwenhoek Hospital ; IRCCS Istituto Nazionale dei Tumori Milano ; Oslo University Hospital Oslo ; Semmelweis University Budapest ; Institute of Oncology Ljubljana ; Aarhus University Aarhus ; Aarhus University Hospital ; Emma Children's Hospital Amsterdam, Netherlands (Academic Medical Center) ; University of Amsterdam Amsterdam = Universiteit van Amsterdam (UvA) ; Amsterdam UMC - Amsterdam University Medical Center |
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Zeitschrift: | ISSN: 0732-183X, 2023 |
Veröffentlichung: | HAL CCSD ; American Society of Clinical Oncology, 2023 |
Medientyp: | academicJournal |
DOI: | 10.1200/JCO.22.02045 |
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