TY - JOUR
T1 - The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma
AU - Lundgaard, Anni Young
AU - Hjalgrim, Lisa Lyngsie
AU - Rechner, Laura Ann
AU - Lundemann, Michael
AU - Brodin, N Patrik
AU - Joergensen, Morten
AU - Specht, Lena
AU - Maraldo, Maja Vestmoe
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Adolescent young adults
KW - Life years lost
KW - Organs at risk
KW - Pediatrics
KW - Radiation-induced late effects
UR - http://www.scopus.com/inward/record.url?scp=85097411962&partnerID=8YFLogxK
U2 - 10.1007/s00066-020-01721-w
DO - 10.1007/s00066-020-01721-w
M3 - Journal article
C2 - 33300098
SN - 0179-7158
VL - 197
SP - 711
EP - 721
JO - Strahlentherapie und Onkologie
JF - Strahlentherapie und Onkologie
IS - 8
ER -