Risk of Subsequent Leukemia After a Solid Tumor in Childhood: Impact of Bone Marrow Radiation Therapy and Chemotherapy

Journal Article · Sun Nov 01 00:00:00 EDT 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.07.2270· OSTI ID:22644990

Gustave Roussy, Villejuif ^[1]; Schwartz, Boris; Veres, Cristina; Haddy, Nadia; Rubino, Carole; Le Deley, Marie-Cécile; Labbé, Martine; Diop, Fara; Jackson, Angela; Dayet, Florent; Benabdennebi, Aymen; Llanas, Damien; Vu Bezin, Jérémi ^[2]; Gustave Roussy, Villejuif ^[1]; Chavaudra, Jean; Lefkopoulos, Dimitri ^[3]; Deutsch, Eric ^[3]; Oberlin, Odile ^[3]; Vathaire, Florent de; Diallo, Ibrahima ^[2] ; Gustave Roussy, Villejuif ^[1]

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1. France
2. Inserm, Radiation Epidemiology Team, CESP-Unit 1018, Villejuif (France)
3. Gustave Roussy, Villejuif (France)

Purpose: To investigate the roles of radiation therapy and chemotherapy in the occurrence of subsequent leukemia after childhood cancer. Methods and Materials: We analyzed data from a case-control study with 35 cases and 140 controls. The active bone marrow (ABM) was segmented into 19 compartments, and the radiation dose was estimated in each. The chemotherapy drug doses were also estimated to enable adjustments. Models capable of accounting for radiation dose heterogeneity were implemented for analysis. Results: Univariate analysis showed a significant trend in the increase of secondary leukemia risk with radiation dose, after accounting for dose heterogeneity (P=.046). This trend became nonsignificant after adjustment for doses of epipodophyllotoxins, alkylating agents, and platinum compounds and the first cancer on multivariate analysis (P=.388). The role of the radiation dose appeared to be dwarfed, mostly by the alkylating agents (odds ratio 6.9, 95% confidence interval 1.9-25.0). Among the patients who have received >16 Gy to the ABM, the radiogenic risk of secondary leukemia was about 4 times greater in the subgroup with no alkylating agents than in the subgroup receiving ≥10 g/m{sup 2}. Conclusions: Notwithstanding the limitations resulting from the size of our study population and the quite systematic co-treatment with chemotherapy, the use of detailed information on the radiation dose distribution to ABM enabled consideration of the role of radiation therapy in secondary leukemia induction after childhood cancer.

• OSTI ID: 22644990
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 93, Issue 3; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ALKYLATING AGENTS
BONE MARROW
CHEMOTHERAPY
GY RANGE 10-100
LEUKEMIA
MULTIVARIATE ANALYSIS
PLATINUM COMPOUNDS
RADIATION DOSE DISTRIBUTIONS
RADIATION HAZARDS
RADIOTHERAPY