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Chounta S, Lemler S, Haddy N, Fresneau B, Mansouri I, Bentriou M, Demoor-Goldschmidt C, Diallo I, Souchard V, Do TD, Veres C, Surun A, Doz F, Llanas D, Vu-Bezin G, Rubino C, de Vathaire F, Letort V, Allodji RS. The risk of valvular heart disease in the French Childhood Cancer Survivors' Study: Contribution of dose-volume histogram parameters. Radiother Oncol 2023; 180:109479. [PMID: 36657724 DOI: 10.1016/j.radonc.2023.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Valvular Heart Disease (VHD) is a known complication of childhood cancer after radiotherapy treatment. However, the dose-volume-effect relationships have not been fully explored. MATERIALS AND METHODS We obtained individual heart Dose Volume Histograms (DVH) for survivors of the French Childhood Cancer Survivors Study (FCCSS) who had received radiotherapy. We calculated the Mean Dose to the Heart (MHD) in Gy, as well as the heart DVH parameters (Vd Gy, which represents the percentage of heart volume receiving at least d Gy), fixing the thresholds to 0.1 Gy, 5 Gy, 20 Gy, and 40 Gy. We analyzed them furtherly in the subpopulation of the cohort that was treated with a dose lower than 5 Gy (V0.1Gy|V5Gy=0%), 20 Gy (V5Gy|V20Gy=0%), and 40 Gy (V20Gy|V40Gy=0%), respectively. We investigated their role in the occurrence of a VHD in this population-based observational cohort study using the Cox proportional hazard model, adjusting for age at cancer diagnosis and chemotherapy exposure. RESULTS Median follow-up was 30.6 years. Eighty-one patients out of the 7462 (1 %) with complete data experienced a severe VHD (grade ≥ 3). The risk of VHD increased along with the MHD, and it was associated with high doses to the heart (V40Gy < 50 %, hazard ratio (HR) = 7.96, 95 % CI: 4.26-14.88 and V20Gy|V40Gy=0% >50 %, HR = 5.03, 95 % CI: [2.35-10.76]). Doses 5-20 Gy to more than 50 % (V5Gy|V20Gy=0% >50 %) of the heart induced a marginally non-significant estimated risk. We also observed a remarkable risk increase with attained age. CONCLUSIONS Our results provide new insight into the VHD risk that may impact current treatments and long-term follow-up of childhood cancer survivors.
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Affiliation(s)
- Stefania Chounta
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Sarah Lemler
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Nadia Haddy
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric oncology, Villejuif, F-94805, France
| | - Imene Mansouri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; EPI-PHARE Scientific Interest Group, Saint-Denis, France; French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | - Mahmoud Bentriou
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Charlotte Demoor-Goldschmidt
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Chu de Nantes, Pediatric Oncology, 38 Bd Jean Monnet, Nantes 44093, France
| | - Ibrahima Diallo
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Vincent Souchard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Thi-Duyen Do
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Cristina Veres
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Aurore Surun
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France; Université Paris Cité, Paris, France
| | - Damien Llanas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Giao Vu-Bezin
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Carole Rubino
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Florent de Vathaire
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Véronique Letort
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Rodrigue Setcheou Allodji
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
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Wilson LJ, Bryce-Atkinson A, Green A, Li Y, Merchant TE, van Herk M, Vasquez Osorio E, Faught AM, Aznar MC. Image-based data mining applies to data collected from children. Phys Med 2022; 99:31-43. [PMID: 35609381 PMCID: PMC9197776 DOI: 10.1016/j.ejmp.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/14/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Image-based data mining (IBDM) is a novel voxel-based method for analyzing radiation dose responses that has been successfully applied in adult data. Because anatomic variability and side effects of interest differ for children compared to adults, we investigated the feasibility of IBDM for pediatric analyses. METHODS We tested IBDM with CT images and dose distributions collected from 167 children (aged 10 months to 20 years) who received proton radiotherapy for primary brain tumors. We used data from four reference patients to assess IBDM sensitivity to reference selection. We quantified spatial-normalization accuracy via contour distances and deviations of the centers-of-mass of brain substructures. We performed dose comparisons with simplified and modified clinical dose distributions with a simulated effect, assessing their accuracy via sensitivity, positive predictive value (PPV) and Dice similarity coefficient (DSC). RESULTS Spatial normalizations and dose comparisons were insensitive to reference selection. Normalization discrepancies were small (average contour distance < 2.5 mm, average center-of-mass deviation < 6 mm). Dose comparisons identified differences (p < 0.01) in 81% of simplified and all modified clinical dose distributions. The DSCs for simplified doses were high (peak frequency magnitudes of 0.9-1.0). However, the PPVs and DSCs were low (maximum 0.3 and 0.4, respectively) in the modified clinical tests. CONCLUSIONS IBDM is feasible for childhood late-effects research. Our findings may inform cohort selection in future studies of pediatric radiotherapy dose responses and facilitate treatment planning to reduce treatment-related toxicities and improve quality of life among childhood cancer survivors.
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Affiliation(s)
- Lydia J Wilson
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA.
| | - Abigail Bryce-Atkinson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Green
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yimei Li
- St. Jude Children's Research Hospital, Department of Biostatistics, Memphis, TN, USA
| | - Thomas E Merchant
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA
| | - Marcel van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Austin M Faught
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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