Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale

Nils P. Brodin, Ivan R. Vogelius, Maja V. Maraldo, Per Munck Af Rosenschöld, Marianne C. Aznar, Anne Kiil-Berthelsen, Per Nilsson, Thomas Björk-Eriksson, Lena Specht, Sãren M. Bentzen

Research output: Contribution to journalArticle

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Abstract

Background: The authors developed a framework for estimating and comparing the risks of various long-term complications on a common scale and applied it to 3 different techniques for craniospinal irradiation in patients with pediatric medulloblastoma. Methods: Radiation dose-response parameters related to excess hazard ratios for secondary breast, lung, stomach, and thyroid cancer; heart failure, and myocardial infarction were derived from large published clinical series. Combined with age-specific and sex-specific hazards in the US general population, the dose-response analysis yielded excess hazards of complications for a cancer survivor as a function of attained age. After adjusting for competing risks of death, life years lost (LYL) were estimated based on excess hazard and prognosis of a complication for 3-dimensional conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT). Results: Lung cancer contributed most to the estimated LYL, followed by myocardial infarction, and stomach cancer. The estimates of breast or thyroid cancer incidence were higher than those for lung and stomach cancer incidence, but LYL were lower because of the relatively good prognosis. Estimated LYL ranged between 1.90 years for 3D CRT to 0.28 years for IMPT. In a paired comparison, IMPT was associated with significantly fewer LYL than both photon techniques. Conclusions: Estimating the risk of late complications is associated with considerable uncertainty, but including prognosis and attained age at an event to obtain the more informative LYL estimate added relatively little to this uncertainty. Cancer 2012.

Original languageEnglish (US)
Pages (from-to)5432-5440
Number of pages9
JournalCancer
Volume118
Issue number21
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Medulloblastoma
Radiotherapy
Proton Therapy
Pediatrics
Stomach Neoplasms
Conformal Radiotherapy
Lung Neoplasms
Thyroid Neoplasms
Uncertainty
Craniospinal Irradiation
Myocardial Infarction
Breast Neoplasms
Matched-Pair Analysis
Intensity-Modulated Radiotherapy
Incidence
Photons
Survivors
Neoplasms
Heart Failure
Radiation

Keywords

  • late effects
  • life years lost
  • radiotherapy
  • risk modeling
  • secondary cancers

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Brodin, N. P., Vogelius, I. R., Maraldo, M. V., Munck Af Rosenschöld, P., Aznar, M. C., Kiil-Berthelsen, A., ... Bentzen, S. M. (2012). Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale. Cancer, 118(21), 5432-5440. https://doi.org/10.1002/cncr.27536

Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale. / Brodin, Nils P.; Vogelius, Ivan R.; Maraldo, Maja V.; Munck Af Rosenschöld, Per; Aznar, Marianne C.; Kiil-Berthelsen, Anne; Nilsson, Per; Björk-Eriksson, Thomas; Specht, Lena; Bentzen, Sãren M.

In: Cancer, Vol. 118, No. 21, 01.11.2012, p. 5432-5440.

Research output: Contribution to journalArticle

Brodin, NP, Vogelius, IR, Maraldo, MV, Munck Af Rosenschöld, P, Aznar, MC, Kiil-Berthelsen, A, Nilsson, P, Björk-Eriksson, T, Specht, L & Bentzen, SM 2012, 'Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale', Cancer, vol. 118, no. 21, pp. 5432-5440. https://doi.org/10.1002/cncr.27536
Brodin NP, Vogelius IR, Maraldo MV, Munck Af Rosenschöld P, Aznar MC, Kiil-Berthelsen A et al. Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale. Cancer. 2012 Nov 1;118(21):5432-5440. https://doi.org/10.1002/cncr.27536
Brodin, Nils P. ; Vogelius, Ivan R. ; Maraldo, Maja V. ; Munck Af Rosenschöld, Per ; Aznar, Marianne C. ; Kiil-Berthelsen, Anne ; Nilsson, Per ; Björk-Eriksson, Thomas ; Specht, Lena ; Bentzen, Sãren M. / Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale. In: Cancer. 2012 ; Vol. 118, No. 21. pp. 5432-5440.
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AU - Munck Af Rosenschöld, Per

AU - Aznar, Marianne C.

AU - Kiil-Berthelsen, Anne

AU - Nilsson, Per

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N2 - Background: The authors developed a framework for estimating and comparing the risks of various long-term complications on a common scale and applied it to 3 different techniques for craniospinal irradiation in patients with pediatric medulloblastoma. Methods: Radiation dose-response parameters related to excess hazard ratios for secondary breast, lung, stomach, and thyroid cancer; heart failure, and myocardial infarction were derived from large published clinical series. Combined with age-specific and sex-specific hazards in the US general population, the dose-response analysis yielded excess hazards of complications for a cancer survivor as a function of attained age. After adjusting for competing risks of death, life years lost (LYL) were estimated based on excess hazard and prognosis of a complication for 3-dimensional conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT). Results: Lung cancer contributed most to the estimated LYL, followed by myocardial infarction, and stomach cancer. The estimates of breast or thyroid cancer incidence were higher than those for lung and stomach cancer incidence, but LYL were lower because of the relatively good prognosis. Estimated LYL ranged between 1.90 years for 3D CRT to 0.28 years for IMPT. In a paired comparison, IMPT was associated with significantly fewer LYL than both photon techniques. Conclusions: Estimating the risk of late complications is associated with considerable uncertainty, but including prognosis and attained age at an event to obtain the more informative LYL estimate added relatively little to this uncertainty. Cancer 2012.

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