Published January 14, 2014
| Version v1
Journal article
Risk of second bone sarcoma following childhood cancer: role of radiation therapy treatment.
Creators
- Schwartz, Boris
- Benadjaoud, Mohamed Amine
- Cléro, Enora
- Haddy, Nadia
- El-Fayech, Chiraz
- Guibout, Catherine
- Teinturier, Cécile
- Oberlin, Odile
- Veres, Cristina
- Pacquement, Hélène
- Munzer, Martine
- N'Guyen, Tan Dat
- Bondiau, Pierre-Yves
- Berchery, Delphine
- Laprie, Anne
- Hawkins, Mike
- Winter, David
- Lefkopoulos, Dimitri
- Chavaudra, Jean
- Rubino, Carole
- Diallo, Ibrahima
- Bénichou, Jacques
- de Vathaire, Florent
Contributors
Others:
- Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Institut Curie [Paris]
- Institut Jean Godinot [Reims] ; UNICANCER
- Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL) ; UNICANCER-Université Côte d'Azur (UCA)
- Centre Médical ; Institut Claudius Regaud
- Department of Public Health and Epidemiology ; University of Birmingham [Birmingham]
- Département de radiothérapie [Gustave Roussy] ; Institut Gustave Roussy (IGR)
- Unité de biostatistiques [CHU Rouen] ; CHU Rouen ; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU)
- This study was supported by the Ligue Nationale Contre le Cancer (LNCC), Institut de Recherche en Sante ́ Publique (IRESP), Programme Hospitalier de Recherche Clinique (PHRC), Agence Française de Securite Sanitaire et Produits de Sante ́ (AFFSAPS), the Pfizer Foundation for Childhood and Adolescent Health.
Description
: Bone sarcoma as a second malignancy is rare but highly fatal. The present knowledge about radiation-absorbed organ dose-response is insufficient to predict the risks induced by radiation therapy techniques. The objective of the present study was to assess the treatment-induced risk for bone sarcoma following a childhood cancer and particularly the related risk of radiotherapy. Therefore, a retrospective cohort of 4,171 survivors of a solid childhood cancer treated between 1942 and 1986 in France and Britain has been followed prospectively. We collected detailed information on treatments received during childhood cancer. Additionally, an innovative methodology has been developed to evaluate the dose-response relationship between bone sarcoma and radiation dose throughout this cohort. The median follow-up was 26 years, and 39 patients had developed bone sarcoma. It was found that the overall incidence was 45-fold higher [standardized incidence ratio 44.8, 95 % confidence interval (CI) 31.0-59.8] than expected from the general population, and the absolute excess risk was 35.1 per 100,000 person-years (95 % CI 24.0-47.1). The risk of bone sarcoma increased slowly up to a cumulative radiation organ absorbed dose of 15 Gy [hazard ratio (HR) = 8.2, 95 % CI 1.6-42.9] and then strongly increased for higher radiation doses (HR for 30 Gy or more 117.9, 95 % CI 36.5-380.6), compared with patients not treated with radiotherapy. A linear model with an excess relative risk per Gy of 1.77 (95 % CI 0.6213-5.935) provided a close fit to the data. These findings have important therapeutic implications: Lowering the radiation dose to the bones should reduce the incidence of secondary bone sarcomas. Other therapeutic solutions should be preferred to radiotherapy in bone sarcoma-sensitive areas.
Abstract
International audienceAdditional details
Identifiers
- URL
- https://www.hal.inserm.fr/inserm-00935692
- URN
- urn:oai:HAL:inserm-00935692v1
Origin repository
- Origin repository
- UNICA