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Heymer EJ, Hawkins MM, Winter DL, Teepen JC, Sunguc C, Ronckers CM, Allodji RS, Alessi D, Sugden E, Belle FN, Bagnasco F, Byrne J, Bárdi E, Garwicz S, Grabow D, Jankovic M, Kaatsch P, Kaiser M, Michel G, Schindera C, Haddy N, Journy N, Česen Mazić M, Skinner R, Kok JL, Gunnes MW, Wiebe T, Sacerdote C, Maule MM, Terenziani M, Jakab Z, Winther JF, Lähteenmäki PM, Zadravec Zaletel L, Haupt R, Kuehni CE, Kremer LC, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent gliomas and meningiomas among 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2024; 130:976-986. [PMID: 38243010 PMCID: PMC10951281 DOI: 10.1038/s41416-024-02577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk of subsequent gliomas and meningiomas, but the risks beyond age 40 years are uncertain. We quantified these risks in the largest ever cohort. METHODS Using data from 69,460 5-year childhood cancer survivors (diagnosed 1940-2008), across Europe, standardized incidence ratios (SIRs) and cumulative incidence were calculated. RESULTS In total, 279 glioma and 761 meningioma were identified. CNS tumour (SIR: 16.2, 95% CI: 13.7, 19.2) and leukaemia (SIR: 11.2, 95% CI: 8.8, 14.2) survivors were at greatest risk of glioma. The SIR for CNS tumour survivors was still 4.3-fold after age 50 (95% CI: 1.9, 9.6), and for leukaemia survivors still 10.2-fold after age 40 (95% CI: 4.9, 21.4). Following cranial radiotherapy (CRT), the cumulative incidence of a glioma in CNS tumour survivors was 2.7%, 3.7% and 5.0% by ages 40, 50 and 60, respectively, whilst for leukaemia this was 1.2% and 1.7% by ages 40 and 50. The cumulative incidence of a meningioma after CRT in CNS tumour survivors doubled from 5.9% to 12.5% between ages 40 and 60, and in leukaemia survivors increased from 5.8% to 10.2% between ages 40 and 50. DISCUSSION Clinicians following up survivors should be aware that the substantial risks of meningioma and glioma following CRT are sustained beyond age 40 and be vigilant for symptoms.
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Affiliation(s)
- Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elaine Sugden
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti 33, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maria W Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Riccardo Haupt
- DOPO Clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Scobioala S, Parfitt R, Matulat P, Byrne J, Langer T, Troschel FM, Hesping AE, Clemens E, Kaatsch P, Grabow D, Kaiser M, Spix C, Kremer LC, Calaminus G, Baust K, Kuehni CE, Weiss A, Strebel S, Kuonen R, Elsner S, Haupt R, Garré ML, Gruhn B, Kepak T, Kepakova K, Winther JF, Kenborg L, Rechnitzer C, Hasle H, Kruseova J, Luks A, Lackner H, Bielack S, Beck JD, Jürgens H, van den Heuvel-Eibrink MM, Zolk O, Eich HT, Am Zehnhoff-Dinnesen A. The impact of the temporal sequence of cranial radiotherapy and platin-based chemotherapy on hearing impairment in pediatric and adolescent CNS and head-and-neck cancer patients: A report from the PanCareLIFE consortium. Int J Cancer 2024; 154:320-331. [PMID: 37715472 DOI: 10.1002/ijc.34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
The impact of the temporal sequence by which cranial radiotherapy (CRT) and platin-based chemotherapy (PCth) are administered on sensorineural hearing loss (SNHL) in pediatric and adolescent central nervous system (CNS) and head-and-neck (HN) cancer patients has not yet been studied in detail. We examined the ototoxic effects of sequentially applied CRT and PCth. This study included children and adolescents with CNS and HN tumors who participated in the multicountry PanCareLIFE (PCL) consortium. Audiological outcomes were compared between patients who received CRT prior to PCth and those who received it afterwards. The incidence, degree and posttreatment progression of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated in 141 patients. One hundred and nineteen patients were included in a time-to-onset analysis. Eighty-eight patients received CRT prior to PCth (Group 1) and 53 patients received PCth before CRT (Group 2). Over a median follow-up time of 1.6 years, 72.7% of patients in Group 1 experienced SNHL ≥ MS2b compared to 33.9% in Group 2 (P < .01). A time-to-onset analysis was performed for 74 patients from Group 1 and 45 patients from Group 2. Median time to hearing loss (HL) ≥ MS2b was 1.2 years in Group 1 and 4.4 years in Group 2 (P < .01). Thus, audiological outcomes were better for patients who received CRT after PCth than before. This finding should be further evaluated and considered within clinical practice in order to minimize hearing loss in children and adolescents with CNS and HN tumors.
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Affiliation(s)
- Sergiu Scobioala
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Ross Parfitt
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Peter Matulat
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | | | - Thorsten Langer
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Fabian M Troschel
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Amélie E Hesping
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Eva Clemens
- Erasmus University Medical Centre (EMC), Rotterdam, The Netherlands
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C Kremer
- Academisch Medisch Centrum bij de Universiteit van Amsterdam (AMC), Amsterdam, The Netherlands
- Princess Maxima Center for Pediatric Oncology (PMC), and University of Utrecht, Utrecht, The Netherlands
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Weiss
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sven Strebel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Elsner
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Riccardo Haupt
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Maria-Luisa Garré
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Tomas Kepak
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Pediatric and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ales Luks
- Motol Teaching Hospital, Prague, Czech Republic
| | - Herwig Lackner
- Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Center for Pediatric, Adolescent, and Women's Medicine, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Jörn-Dirk Beck
- Pediatric Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | | | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Rüdersdorf, Germany
| | - Hans Theodor Eich
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
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3
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Scholz-Kreisel P, Becker C, Kaiser M, Mahmoudpour SH, Voigt M, Ressing M, Blettner M, Calaminus G, Baust K, Scholtes C, Zimmermann M, Zeissig SR, Schmidberger H, Karle H, Meyer-Oldenburg S, Kaatsch P, Spix C. Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR. Cancer Causes Control 2024; 35:33-41. [PMID: 37530985 PMCID: PMC10764383 DOI: 10.1007/s10552-023-01760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case-control study to evaluate the impact of chemotherapy (STATT) as well as radiotherapy (SCAR) on the risk of developing a SPN. METHODS Based on the cohort of the German childhood cancer registry (GCCR), we selected patients diagnosed with a first neoplasm before age 15 or younger between 1980 and 2014. We selected those with a SPN at least half a year after the first neoplasm, and matched up to four controls to each case. Therapy data were acquired from various sources, including clinical study centers and treating hospitals. To analyze the impact of radiotherapy, organ doses were estimated by using reconstructed treatment plans. The effect of chemotherapy was analyzed using substance groups summarized after isotoxic dose conversion. RESULTS 1244 cases with a SPN were identified and matched with 4976 controls. Treatment data were acquired for 83% of all match groups (one case and at least one control). Based on preliminary analyses, 98% of all patients received chemotherapy and 54% of all patients were treated with radiotherapy. CONCLUSIONS Based on our data, detailed analyses of dose response relationships and treatment element combinations are possible, leading to a deeper insight into SPN risks after cancer treatments. TRIAL REGISTRATION The study is registered at the German clinical trial register (DRKS) under number DRKS00017847 [45].
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Affiliation(s)
- Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- Federal Offices for Radiation Protection, Neuherberg, Germany.
| | - Cornelia Becker
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seyed Hamidreza Mahmoudpour
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mathias Voigt
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Meike Ressing
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Cathy Scholtes
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Martin Zimmermann
- Department for Pediatric Hematology and Oncology, Children's Hospital, Medical School Hannover, Hannover, Germany
| | - Sylke Ruth Zeissig
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
- Regional Centre Würzburg, Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Würzburg, Germany
| | - Heinz Schmidberger
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Heiko Karle
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sarah Meyer-Oldenburg
- Department for Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR) Division of Childhood Cancer Epidemiology at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Aleshchenko E, Apfelbacher C, Baust K, Calaminus G, Droege P, Glogner J, Horenkamp-Sonntag D, Ihle P, Kaatsch P, Klein M, Kloppe T, Kuepper-Nybelen J, Langer T, Luepkes C, Marschall U, Meier I, Merzenich H, Spix C, Swart E, Trocchi P. VersKiK: Study protocol of an observational registry-based study on the current state of follow-up care and adherence to follow-up guidelines after cancer in childhood or adolescence. Cancer Epidemiol 2023; 87:102469. [PMID: 37806118 DOI: 10.1016/j.canep.2023.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND This article describes the study design of the quantitative part of the VersKiK study, The primary objectives of this study are to examine the occurrence of late effects in survivors of childhood or adolescent cancer (module 1), investigate health-related vulnerabilities and medical service utilization within this survivor group (modules 1 and 3), and assess the alignment between documented follow-up care for cardiological and audiological late effects with guideline recommendations, along with evaluating the extent of adherence among paediatric cancer survivors (module 3). METHODS This is a non-interventional retrospective observational cohort study. It is based on stochastically linked insurance claims data from approximately 150,000 statutory insured persons with information concerning around 25,000-30,000 cancer survivors recorded in the German Childhood Cancer Register (GCCR). To explore adherence to selected follow-up guidelines, intention to treat treatment data from clinical study groups for particular diagnostic entities will be additionally included. DISCUSSION The growing group of survivors after cancer in childhood and adolescence is representing a special population with an increasing demand for life-long healthcare services through relative high probability of late effects. Currently, there is a limited evidence in Germany on utilization of corresponding medical services and adherence to follow-up guidelines. With this study design, we are aiming to address these gaps and, consequently, suggest improvements to existing follow-up guidelines and follow-up care provision in Germany.
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Affiliation(s)
- E Aleshchenko
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany.
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - K Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Droege
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - J Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | | | - P Ihle
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - P Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Klein
- DAK-Gesundheit, Hamburg, Germany
| | - T Kloppe
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | - J Kuepper-Nybelen
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - C Luepkes
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | | | - I Meier
- Techniker Krankenkasse (TK), Hamburg, Germany
| | - H Merzenich
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - C Spix
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - E Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
| | - P Trocchi
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke Univiersity, Magdeburg, Germany
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5
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Cherven B, Quast LF, Klosky JL, Gerhardt CA, Baust K, Calaminus G, Kaatsch P, Hagedoorn M, Tuinman MA, Lehmann V. Contraceptive methods and fertility testing in young adult survivors of childhood cancer. J Assist Reprod Genet 2023; 40:2391-2400. [PMID: 37584730 PMCID: PMC10504164 DOI: 10.1007/s10815-023-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Reproductive health is important, but often neglected in cancer survivorship care. This study explored contraceptive use and factors associated with fertility testing among young adult survivors of childhood cancer in Germany. METHODS Young adult survivors of childhood cancer were identified through the German Childhood Cancer Registry and completed a mailed survey. Survivors were queried regarding contraceptive use, reproductive goals, uncertainty about fertility, and completion or interest in fertility testing. Multivariable stepwise logistic regression models were used to calculate Odds Ratios (OR) and 95% confidence intervals (CI) as a means of identifying factors associated with completion of and interest in fertility testing. RESULTS Survivors (N = 472; 57.8% female; aged 23.3 ± 1.5 years, and 14.9 ± 5.0 years from diagnosis), reported high rates of contraceptive use, including 61.2% using a single method, 30.6% dual methods, and 8.1% no/less effective methods. Few survivors had completed fertility testing (13.0%), although 58.8% were interested. Having been diagnosed during adolescence (OR = 2.66, 95%CI: 1.39-5.09), greater uncertainty about fertility (OR = 1.16, 95%CI: 1.03-1.31), and use of dual contraceptive methods (OR = 1.94, 95%CI: 1.02-3.69) were associated with having completed fertility testing. Factors associated with interest in fertility testing included goals of wanting to have children (OR = 7.76, 95%CI: 3.01-20.04) and greater uncertainty about fertility (OR = 1.19 95%CI: 1.06-1.33). CONCLUSION In this sample of young adults who survived childhood cancer, most reported contraceptive use. Few survivors had completed fertility testing, although more than half were interested. Interventions are needed to address potential barriers to fertility testing and help survivors manage fertility-related uncertainty.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren F Quast
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
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6
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Reulen RC, Winter DL, Diallo I, Veres C, Llanas D, Allodji RS, Bagnasco F, Bárdi E, Feijen EAM, Alessi D, Fidler-Benaoudia MM, Høgsholt S, Teepen JC, Linge H, Haddy N, Byrne J, Debiche G, Grabow D, Gudmundsdottir T, Fauchery R, Zrafi W, Michel G, Øfstaas H, Kaatsch P, Vu-Bezin G, Jenkinson H, Kaiser M, Skinner R, Cole T, Waespe N, Sommer G, Nordenfelt S, Jankovic M, Lähteenmäki Taalas T, Maule MM, van der Pal HJH, Ronckers CM, van Leeuwen FE, Kok JL, Terenziani M, Winther Gunnes M, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, Kremer LCM, Hjorth L, de Vathaire F, Hawkins MM. Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study. J Clin Oncol 2023; 41:3735-3746. [PMID: 37235821 DOI: 10.1200/jco.22.02045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Radiation to the bone and exposure to alkylating agents increases the risk of bone cancer among survivors of childhood cancer, but there is uncertainty regarding the risks of bone tissue radiation doses below 10 Gy and the dose-response relationship for specific types of chemotherapy. METHODS Twelve European countries contributed 228 cases and 228 matched controls to a nested case-control study within a cohort of 69,460 5-year survivors of childhood cancer. Odds ratios (ORs) of developing bone cancer for different levels of cumulative radiation exposure and cumulative doses of specific types of chemotherapy were calculated. Excess ORs were calculated to investigate the shape and extent of any dose-response relationship. RESULTS The OR associated with bone tissue exposed to 1-4 Gy was 4.8-fold (95% CI, 1.2 to 19.6) and to 5-9 Gy was 9.6-fold (95% CI, 2.4 to 37.4) compared with unexposed bone tissue. The OR increased linearly with increasing dose of radiation (Ptrend < .001) up to 78-fold (95% CI, 9.2 to 669.9) for doses of ≥40 Gy. For cumulative alkylating agent doses of 10,000-19,999 and ≥20,000 mg/m2, the radiation-adjusted ORs were 7.1 (95% CI, 2.2 to 22.8) and 8.3 (95% CI, 2.8 to 24.4), respectively, with independent contributions from each of procarbazine, ifosfamide, and cyclophosphamide. Other cytotoxics were not associated with bone cancer. CONCLUSION To our knowledge, we demonstrate-for the first time-that the risk of bone cancer is increased 5- to 10-fold after exposure of bone tissue to cumulative radiation doses of 1-9 Gy. Alkylating agents exceeding 10,000 mg/m2 increase the risk 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide. These substantially elevated risks should be used to develop/update clinical follow-up guidelines and survivorship care plans.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
| | | | | | | | | | | | | | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | - Romain Fauchery
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeanette F Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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7
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Ressing M, Becker C, Müller C, Mahmoudpour SH, Calaminus G, Langer T, Erdmann F, Voigt M, Kaiser M, Kaatsch P, Blettner M, Spix C. Equivalent doses for anticancer agents used in pediatric oncology: A literature review and evaluation of a novel approach for conversion factors. Cancer Rep (Hoboken) 2023; 6:e1811. [PMID: 36975206 PMCID: PMC10172172 DOI: 10.1002/cnr2.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes. AIMS The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional factors, and to compare these approaches. METHODS AND RESULTS A literature review was performed, which identified two main principles of deriving conversion factors: effect-equivalence and equimolar. Thirty-five articles presenting effect equivalence-based factors in the widest sense were found in the literature. Ten articles presented the equimolar approach which can be applied to almost all chemotherapy substances. Based on a comprehensive list of treatment protocols used in German pediatric oncology, we derived alternative conversion factors from typical doses. We compared the conversion factors using Pearson correlation coefficients and linear regression. At least two types of conversion factor were available for each of the 49 substances included. The equivalent effect-based and the typical dose-based factors were highly correlated with a regression coefficient close to 1. The equimolar factors are independent. CONCLUSIONS For substances for which no conversion factor based on some type of effect equivalence has been published so far, a factor based on a typical doses-approach may be used in epidemiological late effects research. Doses aggregated based on the equimolar approach may not be compatible with doses aggregated based on equivalent effects.
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Affiliation(s)
- Meike Ressing
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Cornelia Becker
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | | | - Seyed Hamidreza Mahmoudpour
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and OncologyUniversity Hospital BonnBonnGermany
| | - Thorsten Langer
- Pediatric Oncology and HematologyUniversity Hospital for Children and AdolescentsLübeckGermany
| | - Friederike Erdmann
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Mathias Voigt
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
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8
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van den Hoek Bos- DW, Tuinman MA, Hillen MA, Huijgens FL, Kurpershoek E, Calaminus G, Kaatsch P, Hagedoorn M, Lehmann V. DISCLOSING A HISTORY OF CHILDHOOD CANCER TO ROMANTIC PARTNERS. Psychooncology 2023. [PMID: 36998113 DOI: 10.1002/pon.6130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To describe young adult childhood cancer survivors' disclosure of their cancer history (i.e., disclosure behavior, difficulty, and timing), perceived partner responses, and associations with relationship status satisfaction. METHODS German long-term survivors of childhood cancer (N=509; response rate: 31.3%, age 21-26, 59.7% female) completed a registry-based nationwide survey (embedded mixed methods design, including closed and open-ended questions) on measures about disclosure history (behavior, difficulty, and timing), partner responses, and relationship status satisfaction. Statistical (χ2 -, t-, or F-tests) and qualitative analyses were conducted. RESULTS Half of all survivors always disclosed their cancer history to romantic partners. Thereby, three themes for considering (non-)disclosure were identified: Survivors' attitudes, having integrated cancer as part of their identity, and anticipated effects on romantic relationships. About 40% indicated having no difficulties with disclosing their cancer history. The timing of disclosure varied, with most survivors disclosing after a few dates. Facilitators of disclosure were the visibility of their former illness (e.g., scars), having trust in a (potential) partner, getting older/mature, and previous positive experiences with disclosure. Few survivors (13.8%) had ever experienced negative responses from dating partners. Yet, those who had negative experiences, found it more difficult to disclose their cancer history. Survivors were overall rather satisfied with their relationship status, with partnered survivors reporting greater satisfaction than singles (Hedge's g=1.68); and particularly partnered survivors with past positive responses being most satisfied. CONCLUSIONS Young adult childhood cancer survivors appear rather open in disclosing their cancer history to (potential) romantic partners, and few experienced negative responses. Psycho-educational programs may emphasize such findings in helping to prevent fear of disclosure or avoidance of dating and disclosure among survivors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- D W van den Hoek Bos-
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Hillen
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - F L Huijgens
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - E Kurpershoek
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Kaatsch
- Institute of Medical Biostatistics, University Medical Center Mainz, German Childhood Cancer Registry (GCCR), Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - M Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - V Lehmann
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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9
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Dudley IM, Sunguc C, Heymer EJ, Winter DL, Teepen JC, Belle FN, Bárdi E, Bagnasco F, Gudmundsdottir T, Skinner R, Michel G, Byrne J, Øfstaas H, Jankovic M, Mazić MČ, Mader L, Loonen J, Garwicz S, Wiebe T, Alessi D, Allodji RS, Haddy N, Grabow D, Kaatsch P, Kaiser M, Maule MM, Jakab Z, Gunnes MW, Terenziani M, Zaletel LZ, Kuehni CE, Haupt R, de Vathaire F, Kremer LC, Lähteenmäki PM, Winther JF, Hjorth L, Hawkins MM, Reulen RC. Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study. Cancer 2023; 129:426-440. [PMID: 36444554 PMCID: PMC10099796 DOI: 10.1002/cncr.34561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) are at risk of developing non-Hodgkin lymphoma (NHL) after treatment; however, the risks of developing subsequent primary lymphomas (SPLs), including HL and NHL, after different types of childhood cancer are unknown. The authors quantified the risk of SPLs using the largest cohort of childhood cancer survivors worldwide. METHODS The Pan-European Network for Care of Survivors After Childhood and Adolescent Cancer (PanCare) Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 69,460 five-year survivors of childhood cancer, diagnosed during 1940 through 2008, from 12 European countries. Risks of SPLs were quantified by standardized incidence ratios (SIRs) and relative risks (RRs) using multivariable Poisson regression. RESULTS Overall, 140 SPLs, including 104 NHLs and 36 HLs, were identified. Survivors were at 60% increased risk of an SPL compared with the general population (SIR, 1.6; 95% confidence interval [CI], 1.4-1.9). Survivors were twice as likely to develop NHL (SIR, 2.3; 95% CI, 1.9-2.8), with the greatest risks among survivors of HL (SIR, 7.1; 95% CI, 5.1-10.0), Wilms tumor (SIR, 3.1; 95% CI, 1.7-5.7), leukemia (SIR, 2.8; 95% CI, 1.8-4.4), and bone sarcoma (SIR, 2.7; 95% CI, 1.4-5.4). Treatment with chemotherapy for any cancer doubled the RR of NHL (RR, 2.1; 95% CI, 1.2-3.9), but treatment with radiotherapy did not (RR, 1.2; 95% CI, 0.7-2.0). Survivors were at similar risk of developing a subsequent HL as the general population (SIR, 1.1; 95% CI, 0.8-1.5). CONCLUSIONS In addition to HL, the authors show here for the first time that survivors of Wilms tumor, leukemia, and bone sarcoma are at risk of NHL. Survivors and health care professionals should be aware of the risk of NHL in these survivors and in any survivors treated with chemotherapy.
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Affiliation(s)
- Isabelle M. Dudley
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ceren Sunguc
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Emma J. Heymer
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David L. Winter
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jop C. Teepen
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Fabiën N. Belle
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Center for Primary Care and Public Health (Unisante)University of LausanneLausanneSwitzerland
| | - Edit Bárdi
- St Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineJohannes Kepler University LinzKepler University HospitalLinzAustria
| | | | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Children's HospitalLandspitali University HospitalReykjavikIceland
| | - Roderick Skinner
- Great North Children's HospitalNewcastle upon Tyne Hospitals National Health Service Foundation TrustNewcastle upon TyneUK
- Newcastle University Center for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Gisela Michel
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | | | - Hilde Øfstaas
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
| | - Momcilo Jankovic
- Pediatric ClinicUniversity of Milano‐BicoccaHospital San GerardoMonzaItaly
| | - Maja Česen Mazić
- University Children's Hospital LjubljanaUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Luzius Mader
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Jaqueline Loonen
- Department of HematologyRadboud University Medical CenterNijmegenNetherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Daniela Alessi
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Rodrigue S. Allodji
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Nadia Haddy
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Desiree Grabow
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Milena M. Maule
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer RegistrySecond Department of PediatricsSemmelweis UniversityBudapestHungary
| | - Maria Winther Gunnes
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
- Department of RegistrationCancer Registry of NorwayOsloNorway
| | - Monica Terenziani
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Claudia E. Kuehni
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity Children's Hospital of BernUniversity of BernBernSwitzerland
| | - Riccardo Haupt
- Diagnosis, Observation, Prevention After Oncologic Treatment (DOPO) ClinicDivision of Hematology/OncologyIRCCS Istituto Giannina GasliniGenovaItaly
| | - Florent de Vathaire
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Leontien C. Kremer
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
- Emma Children's HospitalAmsterdamNetherlands
| | - Päivi M. Lähteenmäki
- Department of Pediatrics and Adolescent MedicineTurku University and Turku University HospitalTurkuFinland
| | - Jeanette F. Winther
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Department of Clinical MedicineFaculty of HealthAarhus University and University HospitalAarhusDenmark
| | - Lars Hjorth
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Michael M. Hawkins
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Raoul C. Reulen
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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10
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Sunguc C, Hawkins MM, Winter DL, Dudley IM, Heymer EJ, Teepen JC, Allodji RS, Belle FN, Bagnasco F, Byrne J, Bárdi E, Ronckers CM, Haddy N, Gudmundsdottir T, Garwicz S, Jankovic M, van der Pal HJH, Mazić MČ, Schindera C, Grabow D, Maule MM, Kaatsch P, Kaiser M, Fresneau B, Michel G, Skinner R, Wiebe T, Sacerdote C, Jakab Z, Gunnes MW, Terenziani M, Winther JF, Lähteenmäki PM, Zaletel LZ, Kuehni CE, Kremer LC, Haupt R, de Vathaire F, Hjorth L, Reulen RC. Risk of subsequent primary oral cancer in a cohort of 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study. Br J Cancer 2023; 128:80-90. [PMID: 36319851 DOI: 10.1038/s41416-022-02016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary malignant neoplasms (SPNs), but the risk for rarer types of SPNs, such as oral cancer, is uncertain. Previous studies included few oral SPNs, hence large-scale cohorts are required to identify groups at risks. METHODS The PanCareSurFup cohort includes 69,460 5-year survivors of childhood cancer across Europe. Risks of oral SPNs were defined by standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS One hundred and forty-five oral SPNs (64 salivary gland, 38 tongue, 20 pharynx, 2 lip, and 21 other) were ascertained among 143 survivors. Survivors were at 5-fold risk of an oral SPN (95% CI: 4.4-5.6). Survivors of leukaemia were at greatest risk (SIR = 19.2; 95% CI: 14.6-25.2) followed by bone sarcoma (SIR = 6.4, 95% CI: 3.7-11.0), Hodgkin lymphoma (SIR = 6.2, 95% CI: 3.9-9.9) and soft-tissue sarcoma (SIR = 5.0, 95% CI: 3.0-8.5). Survivors treated with radiotherapy were at 33-fold risk of salivary gland SPNs (95% CI: 25.3-44.5), particularly Hodgkin lymphoma (SIR = 66.2, 95% CI: 43.6-100.5) and leukaemia (SIR = 50.5, 95% CI: 36.1-70.7) survivors. Survivors treated with chemotherapy had a substantially increased risk of a tongue SPN (SIR = 15.9, 95% CI: 10.6-23.7). CONCLUSIONS Previous radiotherapy increases the risk of salivary gland SPNs considerably, while chemotherapy increases the risk of tongue SPNs substantially. Awareness of these risks among both health-care professionals and survivors could play a crucial role in detecting oral SPNs early.
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Affiliation(s)
- Ceren Sunguc
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Isabelle M Dudley
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma J Heymer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Julianne Byrne
- Boyne Research Institute, c/o no. 1, The Maples, Bettystown, Co Meath, A92 C635, Ireland
| | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria and Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Hospital San Gerardo, Via Donizetti, 33, Monza, Italy
| | | | - Maja Česen Mazić
- University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Milena M Maule
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Brice Fresneau
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
- Department of Children and Adolescents Oncology, Gustave Roussy, F-94805, Villejuif, France
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Winther Gunnes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Hematology/Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Pediatrics, Amsterdam, the Netherlands
| | - Riccardo Haupt
- DOPO clinic, Division of Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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11
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Lehmann V, Gerhardt CA, Baust K, Kaatsch P, Hagedoorn M, Tuinman MA. Psychosexual Development and Sexual Functioning in Young Adult Survivors of Childhood Cancer. J Sex Med 2022; 19:1644-1654. [PMID: 36088275 DOI: 10.1016/j.jsxm.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Childhood cancer and its treatment can impair survivors' development throughout life, particularly psychosexual development, which can be affected in complex ways and is crucial for survivors' well-being. Yet, research is scarce. AIM This study assessed psychosexual development (milestone attainment, age at attainment, perceived timing) in young adult survivors of childhood cancer. It further examined sexual satisfaction and sexual functioning, and whether survivors' perceived timing of sexual debut was related to satisfaction or functioning. METHODS A registry-based nationwide survey was completed by N = 492 German survivors of childhood cancer (age 21-26 years, 6-26 years postdiagnosis). They completed standardized measures of psychosexual milestones (eg, first kiss, sexual debut), sexual satisfaction, and sexual functioning. Psychosexual development was compared to normative data (N = 1,533). OUTCOMES Psychosexual development, sexual satisfaction, and sexual functioning were the primary outcome measures. Psychosexual development was characterized in three ways: milestone attainment (yes/no), age at attainment, perceived timing ("right" time, too early/late). RESULTS Milestone attainment was comparable to normative data, except for sexual debut: Survivors were less often experienced (82.5% vs 88%; P = .002) and older at sexual debut (17.4 vs 16.2 years; g = 0.55), but most survivors (58.3%) perceived their timing as "right." Survivors of brain tumors were least likely to have had their sexual debut, but if experienced age at sexual debut was similar to other survivors. Female survivors were somewhat more experienced than males (eg, first kiss, first relationship; <10% difference), but they were somewhat older when they first kissed (g = 0.26). Age at diagnosis was unrelated to milestone attainment. Perceived early/late sexual debut was related to lower satisfaction in female survivors (P = .026), but unrelated to sexual dysfunction. Instead, partnered men reported particularly low dysfunction whereas women reported similar levels of sexual dysfunction irrespective of their relationship status (P = .049). Overall, sexual functioning was favorable (60.2%: not/barely problematic). CLINICAL IMPLICATIONS Most survivors reported favorable sexual satisfaction and functioning, but a minority of survivors may need supportive services. STRENGTHS & LIMITATIONS This project represents one of few large-scale studies on psychosexual development in childhood cancer survivors relative to normative data, and is the first to link development to sexual satisfaction/functioning. Assessing satisfaction/functioning with validated, but brief measures limits detailed insights, but was inclusive of any sexual orientation. Medical background information based on registry data was limited. CONCLUSION Results showed normative psychosexual development (except for sexual debut) in most survivors. A self-determined attitude toward sexuality (ie, engaging in sexual activities at the "right" time) may generally determine positive sexual experiences.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical PsychologyAmsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology The Ohio State University, Columbus, OH, USA
| | - Katja Baust
- Department of Pediatric Hematology and Oncology University Hospital Bonn, Bonn, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR)Institute of Medical Biostatistics Epidemiology and Informatics (IMBEI)University Medical Center Mainz, Mainz, Germany
| | - Mariët Hagedoorn
- Department of Health PsychologyUniversity of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology University of Groningen University Medical Center Groningen, Groningen, The Netherlands
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12
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van der Kooi A, van Dijk M, Broer L, van den Berg M, Laven J, van Leeuwen F, Ronckers C, van der Heiden-van der Loo M, Hudson M, Byrne J, Pluijm S, Spix C, Kaatsch P, Kremer L, Yasui Y, Brooke J, Uitterlinden A, van den Heuvel-Eibrink M, van Dulmen-den Broeder E. 072 Possible modification of BRSK1 on the risk of alkylating chemotherapy-related reduced ovarian function. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Kaatsch P, Trübenbach C, Kaiser M, Erdmann F, Spix C, Grabow D. [The 41,000 long-term survivor cohort of the German Childhood Cancer Registry]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:453-461. [PMID: 35294562 PMCID: PMC8979858 DOI: 10.1007/s00103-022-03507-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES One-third of childhood cancer long-term survivors suffer from severe late effects (e.g., secondary cancer and cardiovascular diseases). The German Childhood Cancer Registry (GCCR) holds approximately 70,000 registered cancer cases, of which more than 41,000 are long-term survivors, with recent follow-up and contact information that can be used for scientific studies on late effects. The characteristics of this cohort are presented, previous late effects studies with the support of the GCCR are described, and the respective participation rates are reported. METHODS For all patients who developed cancer between 1980 and 2019 and were in long-term observation at the GCCR, the distribution of diagnoses, current age, observation time, and number of secondary cancers as of 16 July 2021 was determined. The rates of patients who responded to history queries were computed. The influence of determinants on the participation rate were calculated using generalized estimating equations. RESULTS The cohort comprises 41,466 long-term survivors. Of these, 10% are older than 40 years and 40% had their cancer diagnosis more than 20 years ago. The participation rates range between 30 and 60% and depend on age at diagnosis, the complexity of the study, and the number of previously conducted surveys. A time interval of at least four years between two consecutive contacts seems optimal. CONCLUSIONS Our unique cohort enables population-based research on late effects after childhood cancer. To define a sensible time interval for contacting survivors is essential. In order to ensure that survivors are not contacted too frequently, the number of survivors included in research projects should be as small as possible.
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Affiliation(s)
- Peter Kaatsch
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland.
| | - Claudia Trübenbach
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland
| | - Melanie Kaiser
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland
| | - Friederike Erdmann
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland
| | - Claudia Spix
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland
| | - Desiree Grabow
- Deutsches Kinderkrebsregister (DKKR), Abteilung Epidemiologie von Krebs im Kindesalter, Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz, 55101, Mainz, Deutschland
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14
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Kube SJ, Blattmann C, Bielack SS, Kager L, Kaatsch P, Kühne T, Sorg B, Kevric M, Jabar S, Hallmen E, Sparber-Sauer M, Klingebiel T, Koscielniak E, Dirksen U, Hecker-Nolting S, Gerß JWO. Secondary malignant neoplasms after bone and soft tissue sarcomas in children, adolescents, and young adults. Cancer 2022; 128:1787-1800. [PMID: 35195899 DOI: 10.1002/cncr.34110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Increased survival in young sarcoma patients comes along with a higher incidence of second malignant neoplasms (SMNs). The incidence, latency, histiotype, and outcome of these patients were analyzed because this information is essential to design evidence-based long-term follow-up care programs for young sarcoma survivors. METHODS Patients entered on clinical trials or registered in registries with a primary sarcoma in 1 of the cooperative sarcoma study groups in the framework of the Society for Pediatric Oncology and Hematology (GPOH) were screened for SMNs. Descriptive analysis, the Kaplan-Meier method, the Gray model, the Fine-Gray model, and the Cox regression model were used for the statistical analyses. RESULTS A total of 159 out of 7079 (2.2%) patients were registered with a SMN. Among them, 104 solid SMNs (65%) and 56 hematologic SMNs (35%) occurred. Median latency from first diagnosis of sarcoma to the diagnosis of SMN was 6.8 years (range, 0-26.7 years). Cumulative incidence of SMN was 8.8% after 30 years. Five-year-survival was 67.1% (95% confidence interval [CI], 66.0-68.2) for the 7079 patients and it was 45.1% (95% CI, 36.2-53.6) after the diagnosis of a SMN (subcohort of n = 159 patients). CONCLUSIONS There is a remarkable high cumulative incidence of SMNs after bone and soft tissue sarcomas in children, adolescents, and young adults. Therefore, effective transition as well as risk adapted long-term follow-up care programs should be developed and offered to young sarcoma survivors. LAY SUMMARY Bone sarcomas and soft tissue tumors are rare tumors in children, adolescents, and young adults. The treatment varies, but may comprise chemotherapy, surgery, and/or radiotherapy. Developing a subsequent malignant tumor is a long-term risk for the patients. To better characterize this risk, we analyzed the data of 7079 patients (up to 21 years old) with bone sarcomas or soft tissue tumors. Our findings provide a basis to counsel young sarcoma survivors on their individual risk of subsequent malignant tumors. Moreover, these data can help to establish recommendations for aftercare in young sarcoma survivors.
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Affiliation(s)
- Stefanie J Kube
- Pediatrics 1, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Stefan S Bielack
- Pediatrics 5, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Leo Kager
- Department of Pediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Kühne
- University Children's Hospital Basel, Basel, Switzerland
| | - Benjamin Sorg
- Pediatrics 5, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Matthias Kevric
- Pediatrics 5, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Susanne Jabar
- Cooperative Ewing Sarcoma Study Group, Essen University Hospital, Essen, Germany
| | - Erika Hallmen
- Pediatrics 5, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Thomas Klingebiel
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Ewa Koscielniak
- Pediatrics 5, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany.,University of Tuebingen, Tuebingen, Germany
| | - Uta Dirksen
- Cooperative Ewing Sarcoma Study Group, Essen University Hospital, Essen, Germany
| | | | - Joachim W O Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
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15
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Byrne J, Schmidtmann I, Rashid H, Hagberg O, Bagnasco F, Bardi E, De Vathaire F, Essiaf S, Winther JF, Frey E, Gudmundsdottir T, Haupt R, Hawkins MM, Jakab Z, Jankovic M, Kaatsch P, Kremer LCM, Kuehni CE, Harila-Saari A, Levitt G, Reulen R, Ronckers CM, Maule M, Skinner R, Steliarova-Foucher E, Terenziani M, Zaletel LZ, Hjorth L, Garwicz S, Grabow D. Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer: The PanCareSurFup consortium. Int J Cancer 2022; 150:406-419. [PMID: 34551126 DOI: 10.1002/ijc.33817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P < .0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P = .1105 and P = .0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
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Affiliation(s)
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Humayra Rashid
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - Florent De Vathaire
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Université Paris-Sud Orsay, Villejuif, France
- Department of Research, Gustave Roussy, Villejuif, France
| | - Samira Essiaf
- SIOPE, c/o BLSI, Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Eva Frey
- St. Anna Children's Hospital, Vienna, Austria
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Foundation MBBM, Milan, Italy
- Italian Off-Therapy Register (OTR), Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Arja Harila-Saari
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gill Levitt
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Raoul Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Science, University of Turin and Center for Cancer Prevention (CPO-Piemonte), Torino, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
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16
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Marron M, Brackmann LK, Schwarz H, Hummel-Bartenschlager W, Zahnreich S, Galetzka D, Schmitt I, Grad C, Drees P, Hopf J, Mirsch J, Scholz-Kreisel P, Kaatsch P, Poplawski A, Hess M, Binder H, Hankeln T, Blettner M, Schmidberger H. Identification of Genetic Predispositions Related to Ionizing Radiation in Primary Human Skin Fibroblasts From Survivors of Childhood and Second Primary Cancer as Well as Cancer-Free Controls: Protocol for the Nested Case-Control Study KiKme. JMIR Res Protoc 2021; 10:e32395. [PMID: 34762066 PMCID: PMC8663494 DOI: 10.2196/32395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an interaction between radiation, genetic, and other risk factors is presumed to influence cancer development. OBJECTIVE Therefore, the population-based, nested case-control study KiKme aims to identify differences in genetic predisposition and radiation response between childhood cancer survivors with and without SPNs as well as cancer-free controls. METHODS We conducted a population-based, nested case-control study KiKme. Besides questionnaire information, skin biopsies and saliva samples are available. By measuring individual reactions to different exposures to radiation (eg, 0.05 and 2 Gray) in normal somatic cells of the same person, our design enables us to create several exposure scenarios for the same person simultaneously and measure several different molecular markers (eg, DNA, messenger RNA, long noncoding RNA, copy number variation). RESULTS Since 2013, 101 of 247 invited SPN patients, 340 of 1729 invited FPN patients, and 150 of 246 invited cancer-free controls were recruited and matched by age and sex. Childhood cancer patients were additionally matched by tumor morphology, year of diagnosis, and age at diagnosis. Participants reported on lifestyle, socioeconomical, and anthropometric factors, as well as on medical radiation history, health, and family history of diseases (n=556). Primary human fibroblasts from skin biopsies of the participants were cultivated (n=499) and cryopreserved (n=3886). DNA was extracted from fibroblasts (n=488) and saliva (n=510). CONCLUSIONS This molecular-epidemiological study is the first to combine observational epidemiological research with standardized experimental components in primary human skin fibroblasts to identify genetic predispositions related to ionizing radiation in childhood and SPNs. In the future, fibroblasts of the participants will be used for standardized irradiation experiments, which will inform analysis of the case-control study and vice versa. Differences between participants will be identified using several molecular markers. With its innovative combination of experimental and observational components, this new study will provide valuable data to forward research on radiation-related risk factors in childhood cancer and SPNs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32395.
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Affiliation(s)
- Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Iris Schmitt
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Grad
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johannes Hopf
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Moritz Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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17
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van der Perk MEM, Broer L, Yasui Y, Robison LL, Hudson MM, Laven JSE, van der Pal HJ, Tissing WJE, Versluys B, Bresters D, Kaspers GJL, de Vries ACH, Lambalk CB, Overbeek A, Loonen JJ, Beerendonk CCM, Byrne J, Berger C, Clemens E, Dirksen U, Falck Winther J, Fosså SD, Grabow D, Muraca M, Kaiser M, Kepák T, Kruseova J, Modan-Moses D, Spix C, Zolk O, Kaatsch P, Krijthe JH, Kremer LCM, Brooke RJ, Baedke JL, van Schaik RHN, van den Anker JN, Uitterlinden AG, Bos AME, van Leeuwen FE, van Dulmen-den Broeder E, van der Kooi ALLF, van den Heuvel-Eibrink MM. Effect of Genetic Variation in CYP450 on Gonadal Impairment in a European Cohort of Female Childhood Cancer Survivors, Based on a Candidate Gene Approach: Results from the PanCareLIFE Study. Cancers (Basel) 2021; 13:4598. [PMID: 34572825 PMCID: PMC8470074 DOI: 10.3390/cancers13184598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Female childhood cancer survivors (CCSs) carry a risk of therapy-related gonadal dysfunction. Alkylating agents (AA) are well-established risk factors, yet inter-individual variability in ovarian function is observed. Polymorphisms in CYP450 enzymes may explain this variability in AA-induced ovarian damage. We aimed to evaluate associations between previously identified genetic polymorphisms in CYP450 enzymes and AA-related ovarian function among adult CCSs. METHODS Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function in a discovery cohort of adult female CCSs, from the pan-European PanCareLIFE cohort (n = 743; age (years): median 25.8, interquartile range (IQR) 22.1-30.6). Using two additive genetic models in linear and logistic regression, nine genetic variants in three CYP450 enzymes were analyzed in relation to cyclophosphamide equivalent dose (CED) score and their impact on AMH levels. The main model evaluated the effect of the variant on AMH and the interaction model evaluated the modifying effect of the variant on the impact of CED score on log-transformed AMH levels. Results were validated, and meta-analysis performed, using the USA-based St. Jude Lifetime Cohort (n = 391; age (years): median 31.3, IQR 26.6-37.4). RESULTS CYP3A4*3 was significantly associated with AMH levels in the discovery and replication cohort. Meta-analysis revealed a significant main deleterious effect (Beta (95% CI): -0.706 (-1.11--0.298), p-value = 7 × 10-4) of CYP3A4*3 (rs4986910) on log-transformed AMH levels. CYP2B6*2 (rs8192709) showed a significant protective interaction effect (Beta (95% CI): 0.527 (0.126-0.928), p-value = 0.01) on log-transformed AMH levels in CCSs receiving more than 8000 mg/m2 CED. CONCLUSIONS Female CCSs CYP3A4*3 carriers had significantly lower AMH levels, and CYP2B6*2 may have a protective effect on AMH levels. Identification of risk-contributing variants may improve individualized counselling regarding the treatment-related risk of infertility and fertility preservation options.
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Affiliation(s)
- M. E. Madeleine van der Perk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Linda Broer
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
- Department of Oncology, Division of Survivorship, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Joop S. E. Laven
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Helena J. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Pediatric Oncology-Haematology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Cornelis B. Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Jacqueline J. Loonen
- Department of Haematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Catharina C. M. Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, A92 RY6K Co. Louth, Ireland;
| | - Claire Berger
- Department of Paediatric Oncology, University Hospital, 42 055 Saint-Etienne, France;
- Lyon University, Jean Monnet University, INSERM, U 1059, Sainbiose, 42023 Saint-Etienne, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, 45147 Essen, Germany;
- German Cancer Research Centre, DKTK, Site Essen, 45147 Essen, Germany
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark
| | - Sophie D. Fosså
- Department of Oncology, Oslo University Hospital, 0372 Oslo, Norway;
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Tomáš Kepák
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, 656 91 Brno, Czech Republic;
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 16816 Neuruppin, Germany;
| | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Jesse H. Krijthe
- Department of Intelligent Systems, Delft University of Technology, 2628 BL Delft, The Netherlands;
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Russell J. Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Jessica L. Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Ron H. N. van Schaik
- Department of clinical chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - John N. van den Anker
- Division of Clinical Pharmacology, Children’s National Hospital, Washington, DC 20010, USA;
| | - André G. Uitterlinden
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Annelies M. E. Bos
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, 3584 CS Utrecht, The Netherlands;
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Anne-Lotte L. F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
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Neu MA, Schlecht J, Schmidt MF, Robinson AL, Spix C, Grabow D, Kaatsch P, Erdmann F, Faber J, Urschitz MS. Mental health and health-related quality of life in preschool-aged childhood cancer survivors. Results of the prospective cohort study ikidS-OEVA. Pediatr Blood Cancer 2021; 68:e29039. [PMID: 33960635 DOI: 10.1002/pbc.29039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Long-term survivors of childhood cancer are at increased risk for sequelae such as poor mental health (MH) or impaired health-related quality of life (HrQoL). We aimed to evaluate early adverse effects on MH and HrQoL in young childhood cancer survivors (YCCS) before school entry. METHODS In a nationwide prospective cohort study, children with cancer other than brain tumors diagnosed at preschool age and completed cancer treatments were identified from the German Childhood Cancer Registry. The comparison group was children of the same age without a cancer diagnosis who participated in the prospective population-based health survey ikidS. MH problems and HrQoL were assessed by parental versions of the Strengths and Difficulties Questionnaire (SDQ) and the questionnaire for health-related quality of life in children (KINDL), respectively. Associations between cancer and MH as well as HrQoL were analyzed by multivariable linear regression. RESULTS Of 382 YCCS contacted, 145 were enrolled (mean age 6.6 years) and 124 analyzed. Compared to children without a cancer diagnosis (3683 contacted, 2003 enrolled, 1422 analyzed), YCCS had more MH problems (13% vs. 3%) and slightly worse HrQoL (median 78.7 vs. 80.2 points). In the adjusted analysis, YCCS had higher SDQ scores (2.2 points, 95% confidence interval [CI] 1.3, 3.0) and lower KINDL scores (-2.4 points, 95% CI -3.7, -1.1) compared to children without cancer diagnosis. CONCLUSION Already at preschool age, YCCS may be at increased risk of MH problems and impaired HrQoL. This could have impacts on subsequent school performance and educational attainment. Follow-up health care for YCCS may include early screening for MH problems and reasons for HrQoL deficits.
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Affiliation(s)
- Marie A Neu
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jennifer Schlecht
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Martina F Schmidt
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Abigale L Robinson
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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19
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Meijer AJM, Diepstraten FA, Langer T, Broer L, Domingo IK, Clemens E, Uitterlinden AG, de Vries ACH, van Grotel M, Vermeij WP, Ozinga RA, Binder H, Byrne J, van Dulmen-den Broeder E, Garrè ML, Grabow D, Kaatsch P, Kaiser M, Kenborg L, Winther JF, Rechnitzer C, Hasle H, Kepak T, Kepakova K, Tissing WJE, van der Kooi ALF, Kremer LCM, Kruseova J, Pluijm SMF, Kuehni CE, van der Pal HJH, Parfitt R, Spix C, Tillmanns A, Deuster D, Matulat P, Calaminus G, Hoetink AE, Elsner S, Gebauer J, Haupt R, Lackner H, Blattmann C, Neggers SJCMM, Rassekh SR, Wright GEB, Brooks B, Nagtegaal AP, Drögemöller BI, Ross CJD, Bhavsar AP, Am Zehnhoff-Dinnesen AG, Carleton BC, Zolk O, van den Heuvel-Eibrink MM. TCERG1L allelic variation is associated with cisplatin-induced hearing loss in childhood cancer, a PanCareLIFE study. NPJ Precis Oncol 2021; 5:64. [PMID: 34262104 PMCID: PMC8280110 DOI: 10.1038/s41698-021-00178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer. These results were replicated in two independent, similarly treated cohorts (n = 192 and 188, respectively) (combined cohort: P = 5.3 × 10-10, OR 3.11, 95% CI 2.2-4.5). Modulating TCERG1L expression in cultured human cells revealed significantly altered cellular responses to cisplatin-induced cytokine secretion and toxicity. These results contribute to insights into the genetic and pathophysiological basis of cisplatin-induced ototoxicity.
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Affiliation(s)
- A J M Meijer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - F A Diepstraten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - T Langer
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | - L Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - I K Domingo
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - E Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M van Grotel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - W P Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - R A Ozinga
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - H Binder
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - J Byrne
- Boyne Research Institute, Drogheda, Ireland
| | - E van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- VU Medical Center, Amsterdam, The Netherlands
| | - M L Garrè
- Department of Neurooncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - D Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - P Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - L Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - J F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - C Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic
- International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - K Kepakova
- University Hospital Brno, Brno, Czech Republic
- International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A L F van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J Kruseova
- Department of Children Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
| | - S M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - R Parfitt
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - C Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - A Tillmanns
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - D Deuster
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - P Matulat
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - G Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - A E Hoetink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Utrecht, Utrecht, The Netherlands
| | - S Elsner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - J Gebauer
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - R Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - H Lackner
- Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - C Blattmann
- Department of Pediatric Oncology/Hematology/Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - S J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S R Rassekh
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - G E B Wright
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - B Brooks
- Audiology and Speech Pathology Department, BC Children's Hospital, Vancouver, BC, Canada
| | - A P Nagtegaal
- Departement of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B I Drögemöller
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - C J D Ross
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - A P Bhavsar
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - A G Am Zehnhoff-Dinnesen
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - B C Carleton
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, British Columbia, Canada
| | - O Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Rüdersdorf, Germany
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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20
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van den Berg MH, van Dijk M, Byrne J, Berger C, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, Haupt R, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, van der Kooi ALF, Kremer LCM, Kruseova J, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Spix C, Twisk JWR, Ronckers CM, Kaatsch P, van Dulmen-den Broeder E. Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod 2021; 36:1561-1573. [PMID: 33744927 DOI: 10.1093/humrep/deab035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M van Dijk
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Byrne
- Boyne Research Institute, Department of Epidemiology, Drogheda, Ireland
| | - C Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Etienne, France
| | - U Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - J F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - S D Fossa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - D Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | | | - R Haupt
- Gaslini Children Hospital, Epidemiology and Biostatistics Section, Genova, Italy
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - A L F van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Leiper
- Great Ormond Street Children's Hospital, London, UK
| | - D Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, THE Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Institute for Biostatistics and Registry Research, Medical University Brandenburg, Neuruppin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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21
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Scholtes C, Baust K, Weinhold L, Creutzig U, Gnekow A, Hinz A, Kaatsch P, Kreitz K, Langer T, Rutkowski S, Singer S, Spix C, Teske C, Schmid M, Dilloo D, Calaminus G. Health status, health-related quality of life, and socioeconomic outcome in childhood brain tumor survivors: a German cohort study. Neuro Oncol 2021; 21:1069-1081. [PMID: 30793186 DOI: 10.1093/neuonc/noz044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With rising numbers of childhood cancer survivors, somatic and socioeconomic outcome as well as health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health, and Quality of Life of Childhood Cancer Survivors, the VIVE survey, we report the outcome of survivors of childhood brain tumors localized in the posterior fossa. METHODS Two hundred seventy participants with a median follow-up period of 21.9 years completed a questionnaire on socioeconomic and somatic late effects as well as a standardized QoL questionnaire (European Organisation for Research and Treatment of Cancer QLQ-C30). Comparisons were performed between World Health Organization (WHO) grades I-II, WHO grades III-IV brain tumor survivors (BTS), and the general population adjusting for potential confounders. RESULTS The socioeconomic and QoL results of WHO grades I-II BTS were largely comparable to the general population, while grades III-IV BTS were at higher risk for significantly worse outcomes. Of WHO grades III-IV BTS, 36.8% were still living with their parents or in assisted living facilities compared with 16.1% of grades I-II BTS and 7.8% of the age-adjusted general population. Of grades III-IV BTS, 60.8% achieved at least an intermediate school degree in comparison to 80.5% of grades I-II BTS and 75.6% of the general population. Grades III-IV BTS developed up to 2 times more somatic late effects than survivors of grades I-II tumors. CONCLUSION Derived from a large and homogeneous cohort, these results stress the importance of an appropriate follow-up period focusing not only on physical aspects but encompassing the entire living situation to allow patient-tailored support.
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Affiliation(s)
- Cathy Scholtes
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Astrid Gnekow
- Pediatric Hematology/Oncology, Children's Hospital Augsburg, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Kiana Kreitz
- Institute for Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Thorsten Langer
- Pediatric Hematology/Oncology, University Children's Hospital Lübeck, Germany
| | - Stefan Rutkowski
- Pediatric Hematology/Oncology, University Children's Hospital Hamburg, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Carmen Teske
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Dagmar Dilloo
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
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22
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van der Kooi ALLF, van Dijk M, Broer L, van den Berg MH, Laven JSE, van Leeuwen FE, Lambalk CB, Overbeek A, Loonen JJ, van der Pal HJ, Tissing WJ, Versluys B, Bresters D, Beerendonk CCM, Ronckers CR, van der Heiden-van der Loo M, Kaspers GL, de Vries ACH, Robison LL, Hudson MM, Chemaitilly W, Byrne J, Berger C, Clemens E, Dirksen U, Falck Winther J, Fosså SD, Grabow D, Haupt R, Kaiser M, Kepak T, Kruseova J, Modan-Moses D, Pluijm SMF, Spix C, Zolk O, Kaatsch P, Krijthe JH, Kremer LC, Yasui Y, Brooke RJ, Uitterlinden AG, van den Heuvel-Eibrink MM, van Dulmen-den Broeder E. Possible modification of BRSK1 on the risk of alkylating chemotherapy-related reduced ovarian function. Hum Reprod 2021; 36:1120-1133. [PMID: 33582778 PMCID: PMC7970730 DOI: 10.1093/humrep/deaa342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/05/2020] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Do genetic variations in the DNA damage response pathway modify the adverse effect of alkylating agents on ovarian function in female childhood cancer survivors (CCS)? SUMMARY ANSWER Female CCS carrying a common BR serine/threonine kinase 1 (BRSK1) gene variant appear to be at 2.5-fold increased odds of reduced ovarian function after treatment with high doses of alkylating chemotherapy. WHAT IS KNOWN ALREADY Female CCS show large inter-individual variability in the impact of DNA-damaging alkylating chemotherapy, given as treatment of childhood cancer, on adult ovarian function. Genetic variants in DNA repair genes affecting ovarian function might explain this variability. STUDY DESIGN, SIZE, DURATION CCS for the discovery cohort were identified from the Dutch Childhood Oncology Group (DCOG) LATER VEVO-study, a multi-centre retrospective cohort study evaluating fertility, ovarian reserve and risk of premature menopause among adult female 5-year survivors of childhood cancer. Female 5-year CCS, diagnosed with cancer and treated with chemotherapy before the age of 25 years, and aged 18 years or older at time of study were enrolled in the current study. Results from the discovery Dutch DCOG-LATER VEVO cohort (n = 285) were validated in the pan-European PanCareLIFE (n = 465) and the USA-based St. Jude Lifetime Cohort (n = 391). PARTICIPANTS/MATERIALS, SETTING, METHODS To evaluate ovarian function, anti-Müllerian hormone (AMH) levels were assessed in both the discovery cohort and the replication cohorts. Using additive genetic models in linear and logistic regression, five genetic variants involved in DNA damage response were analysed in relation to cyclophosphamide equivalent dose (CED) score and their impact on ovarian function. Results were then examined using fixed-effect meta-analysis. MAIN RESULTS AND THE ROLE OF CHANCE Meta-analysis across the three independent cohorts showed a significant interaction effect (P = 3.0 × 10-4) between rs11668344 of BRSK1 (allele frequency = 0.34) among CCS treated with high-dose alkylating agents (CED score ≥8000 mg/m2), resulting in a 2.5-fold increased odds of a reduced ovarian function (lowest AMH tertile) for CCS carrying one G allele compared to CCS without this allele (odds ratio genotype AA: 2.01 vs AG: 5.00). LIMITATIONS, REASONS FOR CAUTION While low AMH levels can also identify poor responders in assisted reproductive technology, it needs to be emphasized that AMH remains a surrogate marker of ovarian function. WIDER IMPLICATIONS OF THE FINDINGS Further research, validating our findings and identifying additional risk-contributing genetic variants, may enable individualized counselling regarding treatment-related risks and necessity of fertility preservation procedures in girls with cancer. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the PanCareLIFE project that has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602030. In addition, the DCOG-LATER VEVO study was funded by the Dutch Cancer Society (Grant no. VU 2006-3622) and by the Children Cancer Free Foundation (Project no. 20) and the St Jude Lifetime cohort study by NCI U01 CA195547. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Anne-Lotte L F van der Kooi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Dijk
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marleen H van den Berg
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline J Loonen
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Wim J Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology/Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology, Wilhelmina Children’s Hospital/University Medical Center, Utrecht, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Willem-Alexander Children’s Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cécile R Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Neuruppin, Germany
| | | | - Gertjan L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric oncology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Leslie L Robison
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Claire Berger
- Department of Paediatric Oncology, University Hospital, St-Etienne, France
- Epidemiology of Childhood and Adolescent Cancers, CRESS, INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, Essen, Germany
- German Cancer Consortium, DKTK, Site Essen, Essen, Germany
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
- DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Tomas Kepak
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, Brno, Czech Republic
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University Hospital Ulm, Ulm, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Jesse H Krijthe
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Yutaka Yasui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Russell J Brooke
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric oncology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Paediatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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23
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Hilgendorf I, Bergelt C, Bokemeyer C, Kaatsch P, Seifart U, Stein A, Langer T. Long-Term Follow-Up of Children, Adolescents, and Young Adult Cancer Survivors. Oncol Res Treat 2021; 44:184-189. [PMID: 33592618 DOI: 10.1159/000514381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
Abstract
Background and Summary: Thanks to increasing cure rates to currently >80%, children, adolescents, and young adults (CAYA) survive their cancer much more frequently today than decades ago. Due to their long life expectancy, CAYA cancer survivors are at a particular risk of long-term sequelae from the cancer itself or the therapy applied; this requires specific follow-up, and preventative or even therapeutic interventions. Thus, compared to the normal population, morbidity and mortality may be significantly increased. In 2 of 3 survivors, the cancer and the respective treatment can lead to late effects, even after 30 years, which require specific therapy; in about one-third of these cases, these effects are classed as severe. Applying structured follow-up could identify these late effects at an early stage and initiate immediate treatment. In 2018, a working group dealing with long-term survival after cancer detected <40 years of age was founded within the framework of the National Cancer Plan of the German Federal Ministry of Health.
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Affiliation(s)
- Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany,
| | - Corinna Bergelt
- Zentrum für Psychosoziale Medizin, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Hubertus Wald Tumor Zentrum, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Kaatsch
- Deutsches Kinderkrebsregister am Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes-Gutenberg- Universität Mainz, Mainz, Germany
| | - Ulf Seifart
- Klinik für Hämatologie und Onkologie, Klinik Sonnenblick der Deutschen Rentenversicherung Hessen, Marburg, Germany
| | - Alexander Stein
- Hämatologisch-Onkologische Praxis Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Langer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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24
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Calaminus G, Baust K, Berger C, Byrne J, Binder H, Casagranda L, Grabow D, Grootenhuis M, Kaatsch P, Kaiser M, Kepak T, Kepáková K, Kremer LCM, Kruseova J, Luks A, Spix C, van den Berg M, van den Heuvel-Eibrink MMM, van Dulmen-den Broeder E, Kuonen R, Sommer G, Kuehni C. Health-Related Quality of Life in European Childhood Cancer Survivors: Protocol for a Study Within PanCareLIFE. JMIR Res Protoc 2021; 10:e21851. [PMID: 33492237 PMCID: PMC7870350 DOI: 10.2196/21851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/13/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Survival after childhood cancer has improved to more than 80% during the last few years, leading to an increased number of childhood cancer survivors. Cancer itself, or its treatment, may cause chronic health conditions, including somatic and mental sequelae, which may affect survivors’ health-related quality of life (HRQoL). Objective The project PanCareLIFE aims to establish a large database with comprehensive data on childhood cancer survivors from different European countries, including data on HRQoL. Within PanCareLIFE, this study aims to describe HRQoL in survivors, investigate predictors of HRQoL, and describe the association of HRQoL with hearing and female fertility impairment. This paper describes the design of the HRQoL study, the origin of data, strategies for data collection, and sampling characteristics of survivors from each contributing country. Methods A total of 6 institutions from 5 European countries (the Czech Republic, France, Germany, the Netherlands, and Switzerland) provided data on HRQoL assessed with the Short Form 36 and on relevant predictors. The central PanCareLIFE data center aggregated the data and harmonized the variables between the institutions. Survivors were eligible if they received a diagnosis of cancer according to the 12 main groups of the International Classification of Childhood Cancer, 3rd edition, or Langerhans cell histiocytosis; were aged ≤18 years at the time of diagnosis; were residents of the respective country at the time of diagnosis; had survived ≥5 years after cancer diagnosis; were aged ≥18 years at the time of the questionnaire survey; and did not refuse to registration in the national or local childhood cancer cohort. Results We identified 24,993 eligible survivors. Of those, 19,268 survivors received a questionnaire and 9871 survivors participated, resulting in response rates of 9871/24,993 (39.50%) of eligible survivors and of 9871/19,268 (51.23%) invited survivors. Most participants were diagnosed with cancer between the ages of 10 and 14 years (3448/9871, 34.93%) or <5 years (3201/9871, 32.43%). The median age was 8 years. Of the 9871 participants, 3157 (31.97%) were survivors of leukemia, 2075 (21.02%) lymphoma, and 1356 (13.7%) central nervous system (CNS) tumors. Most participants (9225/9871, 93.46%) had no history of a subsequent tumor; 77.45% (7645/9871) received chemotherapy with or without other treatments. More than half (5460/9871, 55.31%) were aged 25 to 34 years at the time of the HRQoL study. Participating survivors differed from nonparticipants; participants were more often women, survivors of leukemia or lymphoma, and less frequently, survivors of CNS tumors than nonparticipants. Conclusions PanCareLIFE successfully assessed HRQoL and its predictors in 9871 European survivors of childhood cancer. This large population will permit detailed investigations of HRQoL after childhood cancer, particularly the impact of hearing and female fertility impairment on HRQoL. International Registered Report Identifier (IRRID) RR1-10.2196/21851
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Affiliation(s)
- Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany.,Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany
| | - Katja Baust
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Claire Berger
- Department of Paediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France
| | | | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Leonie Casagranda
- Department of Paediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France.,Host Research Team EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health), Jean Monnet University of Saint-Etienne, PRES (Education and Research Cluster) Lyon, St. Etienne, France
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tomas Kepak
- University Hospital Brno, Masaryk University, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Masaryk University, Brno, Czech Republic
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,DCOG LATER, Utrecht, Netherlands
| | - Jarmila Kruseova
- Department of Paediatric Haematology/Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ales Luks
- Department of Paediatric Haematology/Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marleen van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marry M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,DCOG LATER, Utrecht, Netherlands.,Sophias Childrens Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Grit Sommer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Claudia Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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25
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Reulen RC, Wong KF, Bright CJ, Winter DL, Alessi D, Allodji RM, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EA, Fidler-Benaoudia MM, Diallo I, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Høgsholt S, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Øfstaas H, Ronckers CM, Hau EM, Skinner R, van Leeuwen FE, Teepen JC, Veres C, Zrafi W, Debiche G, Llanas D, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study. Gut 2020; 70:gutjnl-2020-322237. [PMID: 33139271 DOI: 10.1136/gutjnl-2020-322237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide. METHODS The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. RESULTS 427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected. CONCLUSIONS Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Kwok F Wong
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Rodrigue M Allodji
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Instituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Miranda M Fidler-Benaoudia
- Epidemiology and Prevention Research, Departments of Oncology and Community Health Sciences, Calgary, Alberta, Canada
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry, University Medical Centre Mainz, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Public Health England and NHS England & Improvement, Birmingham, UK
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Stine Høgsholt
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Moncilo Jankovic
- Pediatric Clinic, University of Milan-Bicocca, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Helena Linge
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on solid tumors in children, Oslo, Norway
| | - Cecile M Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France
| | - Leontien C Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands
| | - Lars Hjorth
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
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26
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Langer T, Clemens E, Broer L, Maier L, Uitterlinden AG, de Vries AC, van Grotel M, Pluijm SF, Binder H, Mayer B, von dem Knesebeck A, Byrne J, van Dulmen-den Broeder E, Crocco M, Grabow D, Kaatsch P, Kaiser M, Spix C, Kenborg L, Winther JF, Rechnitzer C, Hasle H, Kepak T, van der Kooi ALF, Kremer LC, Kruseova J, Bielack S, Sorg B, Hecker-Nolting S, Kuehni CE, Ansari M, Kompis M, van der Pal HJ, Parfitt R, Deuster D, Matulat P, Tillmanns A, Tissing WJ, Beck JD, Elsner S, am Zehnhoff-Dinnesen A, van den Heuvel-Eibrink MM, Zolk O. Association of candidate pharmacogenetic markers with platinum-induced ototoxicity: PanCareLIFE dataset. Data Brief 2020; 32:106227. [PMID: 32939381 PMCID: PMC7477761 DOI: 10.1016/j.dib.2020.106227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate genes, thiopurine methyltransferase (TPMT) is considered a critical gene for susceptibility to cisplatin-induced hearing loss in a pharmacogenetic guideline. The PanCareLIFE cross-sectional cohort study evaluated the genetic associations in a large pan-European population and assessed the diagnostic accuracy of the genetic markers. 1,112 pediatric cancer survivors who had provided biomaterial for genotyping were screened for participation in the pharmacogenetic association study. 900 participants qualified for inclusion. Based on the assessment of original audiograms, patients were assigned to three phenotype categories: no, minor, and clinically relevant hearing loss. Fourteen variants in eleven candidate genes (ABCC3, OTOS, TPMT, SLC22A2, NFE2L2, SLC16A5, LRP2, GSTP1, SOD2, WFS1, and ACYP2) were genotyped. The genotype and phenotype data represent a resource for conducting meta-analyses to derive a more precise pooled estimate of the effects of genes on the risk of hearing loss due to platinum treatment.
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Affiliation(s)
- Thorsten Langer
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lara Maier
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany
| | | | - Andrica C.H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | - Harald Binder
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Annika von dem Knesebeck
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | | | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, The Netherlands
| | - Marco Crocco
- Department of Neurooncology, Istituto Giannina Gaslini, Genova, Italy
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Line Kenborg
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | - Jeanette F. Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Catherine Rechnitzer
- Copenhagen University Hospital Rigshospitalet, Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
| | - Henrik Hasle
- Aarhus University Hospital, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tomas Kepak
- University Hospital Brno, Brno, Czech Republic, & International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - Anne-Lotte F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC – Sophia Children's Hospital, The Netherlands
| | - Leontien C. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jarmila Kruseova
- Department of Children Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
| | - Stefan Bielack
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Benjamin Sorg
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Stefanie Hecker-Nolting
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Oncology, Dept. of Paediatrics, Inselspital, University of Bern, Switzerland
| | - Marc Ansari
- Department of Pediatrics, Oncology and Hematology Unit, University Hospital of Geneva, Cansearch Research Laboratory, Geneva University, Switzerland
| | - Martin Kompis
- Department of Otolaryngology, Head and Neck Surgery, Inselspital, University of Berne
| | - Heleen J. van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Ross Parfitt
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Dirk Deuster
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Peter Matulat
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Amelie Tillmanns
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Wim J.E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jörn D. Beck
- Hospital for Children and Adolescents, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Susanne Elsner
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Germany
| | - PanCareLIFE consortium
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- Boyne Research Institute, Drogheda, Ireland
- Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, The Netherlands
- Department of Neurooncology, Istituto Giannina Gaslini, Genova, Italy
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Copenhagen University Hospital Rigshospitalet, Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
- Aarhus University Hospital, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
- University Hospital Brno, Brno, Czech Republic, & International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
- Department of Obstetrics and Gynecology, Erasmus MC – Sophia Children's Hospital, The Netherlands
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
- Department of Children Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Oncology, Dept. of Paediatrics, Inselspital, University of Bern, Switzerland
- Department of Pediatrics, Oncology and Hematology Unit, University Hospital of Geneva, Cansearch Research Laboratory, Geneva University, Switzerland
- Department of Otolaryngology, Head and Neck Surgery, Inselspital, University of Berne
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Hospital for Children and Adolescents, University of Erlangen-Nuremberg, Erlangen, Germany
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Germany
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Langer T, Clemens E, Broer L, Maier L, Uitterlinden AG, de Vries ACH, van Grotel M, Pluijm SFM, Binder H, Mayer B, von dem Knesebeck A, Byrne J, van Dulmen-den Broeder E, Crocco M, Grabow D, Kaatsch P, Kaiser M, Spix C, Kenborg L, Winther JF, Rechnitzer C, Hasle H, Kepak T, van der Kooi ALF, Kremer LC, Kruseova J, Bielack S, Sorg B, Hecker-Nolting S, Kuehni CE, Ansari M, Kompis M, van der Pal H, Parfitt R, Deuster D, Matulat P, Tillmanns A, Tissing WJE, Beck JD, Elsner S, Am Zehnhoff-Dinnesen A, van den Heuvel-Eibrink MM, Zolk O. Usefulness of current candidate genetic markers to identify childhood cancer patients at risk for platinum-induced ototoxicity: Results of the European PanCareLIFE cohort study. Eur J Cancer 2020; 138:212-224. [PMID: 32905960 DOI: 10.1016/j.ejca.2020.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Irreversible sensorineural hearing loss is a common side effect of platinum treatment with the potential to significantly impair the neurocognitive, social and educational development of childhood cancer survivors. Genetic association studies suggest a genetic predisposition for cisplatin-induced ototoxicity. Among other candidate genes, thiopurine methyltransferase (TPMT) is considered a critical gene for susceptibility to cisplatin-induced hearing loss in a pharmacogenetic guideline. The aim of this cross-sectional cohort study was to confirm the genetic associations in a large pan-European population and to evaluate the diagnostic accuracy of the genetic markers. METHODS Eligibility criteria required patients to be aged less than 19 years at the start of chemotherapy, which had to include cisplatin and/or carboplatin. Patients were assigned to three phenotype categories: no, minor and clinically relevant hearing loss. Fourteen variants in eleven candidate genes (ABCC3, OTOS, TPMT, SLC22A2, NFE2L2, SLC16A5, LRP2, GSTP1, SOD2, WFS1 and ACYP2) were investigated. Multinomial logistic regression was performed to model the relationship between genetic predictors and platinum ototoxicity, adjusting for clinical risk factors. Additionally, measures of the diagnostic accuracy of the genetic markers were determined. RESULTS 900 patients were included in this study. In the multinomial logistic regression, significant unique contributions were found from SLC22A2 rs316019, the age at the start of platinum treatment, cranial radiation and the interaction term [platinum compound]∗[cumulative dose of cisplatin]. The predictive performance of the genetic markers was poor compared with the clinical risk factors. CONCLUSIONS PanCareLIFE is the largest study of cisplatin-induced ototoxicity to date and confirmed a role for the polyspecific organic cation transporter SLC22A2. However, the predictive value of the current genetic candidate markers for clinical use is negligible, which puts the value of clinical factors for risk assessment of cisplatin-induced ototoxicity back into the foreground.
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Affiliation(s)
- Thorsten Langer
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lara Maier
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Saskia F M Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Harald Binder
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Annika von dem Knesebeck
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | | | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, the Netherlands
| | - Marco Crocco
- Department of Neurooncology, Istituto Giannina Gaslini, Genova, Italy
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Line Kenborg
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Catherine Rechnitzer
- Copenhagen University Hospital Rigshospitalet, Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
| | - Henrik Hasle
- Aarhus University Hospital, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tomas Kepak
- University Hospital Brno, Brno, Czech Republic; International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - Anne-Lotte F van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, the Netherlands
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Jarmila Kruseova
- Department of Children Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
| | - Stefan Bielack
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Benjamin Sorg
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Stefanie Hecker-Nolting
- Department of Pediatric Oncology, Hematology, Immunology, Stuttgart Cancer Center, Olgahospital, Stuttgart, Germany
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Paediatric Oncology, Dept. of Paediatrics, Inselspital, University of Bern, Switzerland
| | - Marc Ansari
- Department of Pediatrics, Oncology and Hematology Unit, University Hospital of Geneva, Cansearch Research Laboratory, Geneva University, Switzerland
| | - Martin Kompis
- Department of Otolaryngology, Head and Neck Surgery, Inselspital, University of Berne, Switzerland
| | - Heleen van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Ross Parfitt
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Dirk Deuster
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Peter Matulat
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Amelie Tillmanns
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jörn D Beck
- Hospital for Children and Adolescents, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Susanne Elsner
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Germany; Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany.
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Feijen EAM, van Dalen EC, van der Pal HJH, Reulen RC, Winter DL, Keuhni CE, Morsellino V, Alessi D, Allodji RS, Byrne J, Bardi E, Jakab Z, Grabow D, Garwicz S, Haddy N, Jankovic M, Kaatsch P, Levitt GA, Ronckers CM, Schindera C, Skinner R, Zalatel L, Hjorth L, Tissing WJE, De Vathaire F, Hawkins MM, Kremer LCM. Increased risk of cardiac ischaemia in a pan-European cohort of 36 205 childhood cancer survivors: a PanCareSurFup study. Heart 2020; 107:33-40. [PMID: 32826285 DOI: 10.1136/heartjnl-2020-316655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE In this report, we determine the cumulative incidence of symptomatic cardiac ischaemia and its risk factors among European 5-year childhood cancer survivors (CCS) participating in the PanCareSurFup study. METHODS Eight data providers (France, Hungary, Italy (two cohorts), the Netherlands, Slovenia, Switzerland and the UK) participating in PanCareSurFup ascertained and validated symptomatic cardiac events among their 36 205 eligible CCS. Data on symptomatic cardiac ischaemia were graded according to the Criteria for Adverse Events V.3.0 (grade 3-5). We calculated cumulative incidences, both overall and for different subgroups based on treatment and malignancy, and used multivariable Cox regression to analyse risk factors. RESULTS Overall, 302 out of the 36 205 CCS developed symptomatic cardiac ischaemia during follow-up (median follow-up time after primary cancer diagnosis: 23.0 years). The cumulative incidence by age 60 was 5.4% (95% CI 4.6% to 6.2%). Men (7.1% (95% CI 5.8 to 8.4)) had higher rates than women (3.4% (95% CI 2.4 to 4.4)) (p<0.0001). Of importance is that a significant number of patients (41/302) were affected as teens or young adults (14-30 years). Treatment with radiotherapy/chemotherapy conferred twofold risk (95% CI 1.5 to 3.0) and cases in these patients appeared earlier than in CCS without treatment/surgery only (15% vs 3% prior to age 30 years, respectively (p=0.04)). CONCLUSIONS In this very large European childhood cancer cohort, we found that by age 60 years, 1 in 18 CCS will develop a severe, life-threatening or fatal cardiac ischaemia, especially in lymphoma survivors and CCS treated with radiotherapy and chemotherapy increases the risk significantly.
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Affiliation(s)
| | - Elvira C van Dalen
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Heleen J H van der Pal
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Zsuzsanna Jakab
- Markusovszky University Teaching Hospital, Szombathely, Vas, Hungary
| | | | | | | | | | | | - Gill A Levitt
- Great Ormond Street Hospital for Children, London, UK
| | - Cecile M Ronckers
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Lorna Zalatel
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lars Hjorth
- Skåne University Hospital Lund, Lund, Sweden
| | - Wim J E Tissing
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Oncology, University of Groningen, Groningen, The Netherlands
| | | | | | - Leontien C M Kremer
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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29
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Scholz-Kreisel P, Kaatsch P, Spix C, Schmidberger H, Marron M, Grabow D, Becker C, Blettner M. Second Malignancies Following Childhood Cancer Treatment in Germany From 1980 to 2014. Dtsch Arztebl Int 2019; 115:385-392. [PMID: 29960606 DOI: 10.3238/arztebl.2018.0385] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/08/2017] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of improvements in cancer treatment, more than 80% of all children with cancer now survive at least five years from the time of diagnosis. As a result, late sequelae of cancer and its treatment have become more common, particularly second malignancies. We studied the current incidence of second malignancies among childhood cancer survivors in Germany. METHODS This study is based on the cohort of the German Childhood Cancer Registry (Deutsches Kinderkrebsregister, DKKR). Persons given the diagnosis of a first malignancy at any time in the years 1980-2014 who were no more than 14 years old at the time of diagnosis and survived at least six months thereafter were included in the study. Cumulative incidences and hazard ratios were calculated, and comparisons with the general population were made with the aid of standardized incidence ratios (SIR). RESULTS Among the 47 650 survivors included in the study, there were 1262 cases of second malignancies. After a follow-up interval of up to 35 years, the cumulative incidence of second malignancies was 8.27% (95% confidence interval [7.51; 9.03]). Second malignancies were more common in female patients (hazard ratio 1.29, [1.16; 1.44]) and in those who had had a systemic cancer as their initial malignancy (hazard ratio 1.22 [1.09; 1.36]). The SIR compared to the general population for the period 1955-2014 was 7.08 [6.42; 7.9] for female patients and 5.83 [5.27; 6.42] for male patients. CONCLUSION The cumulative incidence of second malignancies is 5.4% at 25 years and 8.3% at 35 years; these figures may be slight underestimates. The DKKR is an epidemiologic registry containing no data about treatment, so the effect of treatment on the risk of second malignancies could not be studied. The acquisition and evaluation of treatment data for the overall cohort is currently one of the main tasks for research on the late sequelae of childhood cancer. This may enable conclusions to be drawn about whether treatment strategies that have been introduced to lessen the risk of a second malignancy actually have the desired effect.
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Affiliation(s)
- Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz German Childhood Cancer Registry at the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) at the University Medical Center of the Johannes Gutenberg University Mainz; Department of Radiation Oncology and Radiation Therapy at the University Medical Center of the Johannes Gutenberg University Mainz; Leibniz-Institut für Präventionsforschung und Epidemiologie (BIPS), Bremen
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30
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Allodji RS, Hawkins MM, Bright CJ, Fidler-Benaoudia MM, Winter DL, Alessi D, Fresneau B, Journy N, Morsellino V, Bárdi E, Bautz A, Byrne J, Feijen ELA, Teepen JC, Vu-Bezin G, Rubino C, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Hau EM, Jankovic M, Kaatsch P, Kaiser M, Linge H, Muraca M, Llanas D, Veres C, Øfstaas H, Diallo I, Mansouri I, Ronckers CM, Skinner R, Terenziani M, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, Michel G, Kremer LCM, Hjorth L, Haddy N, de Vathaire F, Reulen RC. Risk of subsequent primary leukaemias among 69,460 five-year survivors of childhood cancer diagnosed from 1940 to 2008 in Europe: A cohort study within PanCareSurFup. Eur J Cancer 2019; 117:71-83. [PMID: 31260818 DOI: 10.1016/j.ejca.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Survivors of childhood cancers are at risk of developing subsequent primary leukaemias (SPLs), but the long-term risks beyond 20 years of treatment are still unclear. We investigated the risk of SPLs in five-year childhood cancer survivors using a large-scale pan-European (PanCareSurFup) cohort and evaluated variations in the risk by cancer and demographic factors. METHODS This largest-ever assembled cohort comprises 69,460 five-year childhood cancer survivors from 12 European countries. Standardised incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. RESULTS One hundred fifteen survivors developed an SPL including 86 myeloid leukaemias (subsequent primary myeloid leukaemias [SPMLs]), 17 lymphoid leukaemias and 12 other types of leukaemias; of these SPLs, 31 (27%) occurred beyond 20 years from the first childhood cancer diagnosis. Compared with the general population, childhood cancer survivors had a fourfold increased risk (SIR = 3.7, 95% confidence interval [CI]: 3.1 to 4.5) of developing leukaemia, and eight leukaemias per 100,000 person-years (AER = 7.5, 95% CI: 6.0 to 9.2) occurred in excess of that expected. The risks remained significantly elevated beyond 20 years from the first primary malignancy (SIR = 2.4, 95% CI: 1.6 to 3.4). Overall, the risk ratio for SPML (SIR = 5.8, 95% CI: 4.6 to 7.1) was higher than that for other SPLs. CONCLUSIONS We demonstrate that beyond 20 years after childhood cancer diagnosis, survivors experience an increased risk for SPLs compared with that expected from the general population. Our findings highlight the need for awareness by survivors and their healthcare providers for potential risk related to SPL.
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Affiliation(s)
- Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Miranda M Fidler-Benaoudia
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Brice Fresneau
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Vera Morsellino
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- St Anna Kinderspital Wien, Austria; Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark
| | | | - Elizabeth Lieke Am Feijen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jop C Teepen
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Giao Vu-Bezin
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Carole Rubino
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Eva-Maria Hau
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Via Cadore 38, 20900 Monza, MB, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Monica Muraca
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Damien Llanas
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Norway
| | - Ibrahima Diallo
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Imene Mansouri
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, And Northern Institute of Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Finn Wesenberg
- Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Päivi Lähteenmäki
- Turku University and Turku University Hospital, Department of Pediatric and Adolescent Medicine, Turku, Finland
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Switzerland
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Amsterdam UMC, Emma Children's Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK; Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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31
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Clemens E, Meijer AJ, Broer L, Langer T, van der Kooi ALL, Uitterlinden AG, de Vries A, Kuehni CE, Garrè ML, Kepak T, Kruseova J, Winther JF, Kremer LC, van Dulmen-den Broeder E, Tissing WJ, Rechnitzer C, Kenborg L, Hasle H, Grabow D, Parfitt R, Binder H, Carleton BC, Byrne J, Kaatsch P, Am Zehnhoff-Dinnesen A, Zolk O, van den Heuvel-Eibrink MM. Genetic Determinants of Ototoxicity During and After Childhood Cancer Treatment: Protocol for the PanCareLIFE Study. JMIR Res Protoc 2019; 8:e11868. [PMID: 30888333 PMCID: PMC6444213 DOI: 10.2196/11868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background Survival rates after childhood cancer now reach nearly 80% in developed countries. However, treatments that lead to survival and cure can cause serious adverse effects with lifelong negative impacts on survivor quality of life. Hearing impairment is a common adverse effect in children treated with cisplatin-based chemotherapy or cranial radiotherapy. Ototoxicity can extend from high-tone hearing impairment to involvement of speech frequencies. Hearing impairment can impede speech and language and neurocognitive development. Although treatment-related risk factors for hearing loss following childhood cancer treatment have been identified, the individual variability in toxicity of adverse effects after similar treatment between childhood cancer patients suggests a role for genetic susceptibility. Currently, 12 candidate gene approach studies have been performed to identify polymorphisms predisposing to platinum-induced ototoxicity in children being treated for cancer. However, results were inconsistent and most studies were underpowered and/or lacked replication. Objective We describe the design of the PanCareLIFE consortium’s work packages that address the genetic susceptibility of platinum-induced ototoxicity. Methods As a part of the PanCareLIFE study within the framework of the PanCare consortium, we addressed genetic susceptibility of treatment-induced ototoxicity during and after childhood cancer treatment in a large European cohort by a candidate gene approach and a genome-wide association screening. Results This study included 1124 survivors treated with cisplatin, carboplatin, or cranial radiotherapy for childhood cancer, resulting in the largest clinical European cohort assembled for this late effect to date. Within this large cohort we defined a group of 598 cisplatin-treated childhood cancer patients not confounded by cranial radiotherapy. The PanCareLIFE initiative provided, for the first time, a unique opportunity to confirm already identified determinants for hearing impairment during childhood cancer using a candidate gene approach and set up the first international genome-wide association study of cisplatin-induced direct ototoxicity in childhood cancer patients to identify novel allelic variants. Results will be validated in an independent replication cohort. Patient recruitment started in January 2015 and final inclusion was October 2017. We are currently performing the analyses and the first results are expected by the end of 2019 or the beginning of 2020. Conclusions Genetic factors identified as part of this pan-European project, PanCareLIFE, may contribute to future risk prediction models that can be incorporated in future clinical trials of platinum-based therapies for cancer and may help with the development of prevention strategies. International Registered Report Identifier (IRRID) DERR1-10.2196/11868
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Affiliation(s)
- Eva Clemens
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Linda Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Thorsten Langer
- Department of Pediatric Oncology, University Hospital for Children and Adolescents, Luebeck, Germany
| | - Anne-Lotte Lf van der Kooi
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.,Department of Obstetrics and Gynecology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Andrica de Vries
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Hematology and Oncology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Paediatric Respiratory Medicine, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Maria L Garrè
- Department of Neurooncology, Institute Giannina Gaslini, Genova, Italy
| | - Tomas Kepak
- Department of Paediatric Oncology, University Hospital Brno, Masaryk University, Brno, Czech Republic.,St. Anne's University Hospital Brno-International Clinical Research Center, Brno, Czech Republic
| | - Jarmila Kruseova
- Department of Pediatric Hemato-Oncology, Motol University Hospital Prague, Prague, Czech Republic
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Leontien C Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, Netherlands
| | - Wim Je Tissing
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Kenborg
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ross Parfitt
- Department of Phoniatrics and Pedaudiology, University of Münster, Muenster, Germany
| | - Harald Binder
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freibug, Germany
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | | | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University Medical Center, Ulm, Germany
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Langer T, Grabow D, Kaatsch P, Creutzig U, Eggert A, Escherich G, Calaminus G. [Long-Term Follow-Up in Childhood Cancer Survivors - Position paper 2018 of the working group "long-term follow-up" of the Society of Pediatric Oncology and Hematology (GPOH) on long-term surveillance, long-term follow-up and late effect evaluation in pediatric oncology patients]. Klin Padiatr 2018; 230:291-298. [PMID: 30399641 DOI: 10.1055/a-0754-2362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nowadays, childhood cancer patients survive much more often than they did 40 years ago. Therefore, the cure rates rise over 80%. Approximately 33,000 cured childhood cancer patients are documented by the German Childhood Cancer Registry (GCCR) for long-term follow-up in Germany. But does that mean, they are healthy, too? When compared to the normal population, it can be seen that morbidity and mortality are significantly higher among former childhood cancer patients. In two out of three survivors, the cancer and its treatments can lead to treatment-related late complications 30 years later; in about one-third, these late complications are classified as severe. A structured long-term follow-up is needed to detect and to treat new diseases early. The purpose of this position paper is to update the first position paper from 2007. Current developments are described, how appropriate aftercare structures and aftercare facilities should be planned, taking into account existing structures and increasing needs.
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Affiliation(s)
- Thorsten Langer
- Pädiatrische Onkologie und Hämatologie, Klinik für Kinder- und Jugendmedizin, Lübeck
| | - Desiree Grabow
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Deutsches Kinderkrebsregister (DKKR), Mainz
| | - Peter Kaatsch
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Deutsches Kinderkrebsregister (DKKR), Mainz
| | - Ursula Creutzig
- Pädiatrische Hämatologie und Onkologie, Medizinische Hochschule Hannonver, Hannover
| | - Angelika Eggert
- Campus Virchow Klinikum, Charité University Medicine, Berlin
| | - Gabriele Escherich
- Clinic for Pediatric Hematology and Oncology, University, Hamburg-Eppendorf
| | - Gabriele Calaminus
- Abteilung für Pädiatrische Hämatologie und Onkologie, Zentrum fur Kinderheilkunde der Universitat Bonn, Bonn
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van der Kooi ALLF, Clemens E, Broer L, Zolk O, Byrne J, Campbell H, van den Berg M, Berger C, Calaminus G, Dirksen U, Winther JF, Fosså SD, Grabow D, Haupt R, Kaiser M, Kepak T, Kremer L, Kruseova J, Modan-Moses D, Ranft A, Spix C, Kaatsch P, Laven JSE, van Dulmen-den Broeder E, Uitterlinden AG, van den Heuvel-Eibrink MM. Genetic variation in gonadal impairment in female survivors of childhood cancer: a PanCareLIFE study protocol. BMC Cancer 2018; 18:930. [PMID: 30257669 PMCID: PMC6158859 DOI: 10.1186/s12885-018-4834-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background Improved risk stratification, more effective therapy and better supportive care have resulted in survival rates after childhood cancer of around 80% in developed countries. Treatment however can be harsh, and three in every four childhood cancer survivors (CCS) develop at least one late effect, such as gonadal impairment. Gonadal impairment can cause involuntary childlessness, with serious consequences for the well-being of CCS. In addition, early menopause increases the risk of comorbidities such as cardiovascular disease and osteoporosis. Inter-individual variability in susceptibility to therapy related gonadal impairment suggests a role for genetic variation. Currently, only one candidate gene study investigated genetic determinants in relation to gonadal impairment in female CCS; it yielded one single nucleotide polymorphism (SNP) that was previously linked with the predicted age at menopause in the general population of women, now associated with gonadal impairment in CCS. Additionally, one genome wide association study (GWAS) evaluated an association with premature menopause, but no GWAS has been performed using endocrine measurements for gonadal impairment as the primary outcome in CCS. Methods As part of the PanCareLIFE study, the genetic variability of chemotherapy induced gonadal impairment among CCS will be addressed. Gonadal impairment will be determined by anti-Müllerian hormone (AMH) levels or alternatively by fertility and reproductive medical history retrieved by questionnaire. Clinical and genetic data from 837 non-brain or non-bilateral gonadal irradiated long-term CCS will result in the largest clinical European cohort assembled for this late-effect study to date. A candidate gene study will examine SNPs that have already been associated with age at natural menopause and DNA maintenance in the general population. In addition, a GWAS will be performed to identify novel allelic variants. The results will be validated in an independent CCS cohort. Discussion This international collaboration aims to enhance knowledge of genetic variation which may be included in risk prediction models for gonadal impairment in CCS.
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Affiliation(s)
- Anne-Lotte L F van der Kooi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. .,Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. .,Princess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
| | - Eva Clemens
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Oliver Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University Hospital Ulm, Ulm, Germany
| | | | | | - Marleen van den Berg
- Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, The Netherlands
| | - Claire Berger
- Department of Paediatric Oncology, University Hospital, St-Etienne, France.,Epidemiology of Childhood and Adolescent Cancers, CRESS, INSERM, UMR 1153, Paris Descartes University, Villejuif, France
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Children's Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Uta Dirksen
- Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany.,German Cancer Research Centre, DKTK, sites Bonn and Essen, Germany
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Tomas Kepak
- Czech Republic & International Clinical Research Center (FNUSA-ICRC), University Hospital Brno, Brno, Czech Republic
| | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.,Department of Pediatrics, Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands
| | | | - Dalit Modan-Moses
- Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Andreas Ranft
- Pediatrics III, West German Cancer Centre, University Hospital Essen, Essen, Germany.,German Cancer Research Centre, DKTK, sites Bonn and Essen, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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van den Berg M, van Dijk M, Byrne J, Campbell H, Berger C, Borgmann-Staudt A, Calaminus G, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, Kremer LC, Kruseova J, Kuehni CE, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Morsellino V, Spix C, Kaatsch P, van Dulmen-den Broeder E. Fertility Among Female Survivors of Childhood, Adolescent, and Young Adult Cancer: Protocol for Two Pan-European Studies (PanCareLIFE). JMIR Res Protoc 2018; 7:e10824. [PMID: 30215599 PMCID: PMC6231763 DOI: 10.2196/10824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022] Open
Abstract
Background Despite a significant number of studies on female fertility following childhood, adolescent, and young adult (CAYA) cancer, studies establishing precise (dose-related) estimates of treatment-related risks are still scarce. Previous studies have been underpowered, did not include detailed treatment information, or were based on self-report only without any hormonal assessments. More precise assessments of who is at risk for sub- or infertility are needed. Objective The objective of our study is to describe the design and methods of 2 studies on female fertility (a cohort study and a nested case-control study) among female survivors of CAYA cancer performed within the European PanCareLIFE project. Methods For the cohort study, which aims to evaluate the overall risk of fertility impairment, as well as the risk for specific subgroups of female CAYA cancer survivors, 13 institutions from 9 countries provide data on fertility impairment. Survivors are defined as being fertility impaired if they meet at least one of 8 different criteria based on self-reported and hormonal data. For the nested case-control study, which aims to identify specific treatment-related risk factors associated with fertility impairment in addition to possible dose-response relationships, cases (fertility impaired survivors) are selected from the cohort study and matched to controls (survivors without fertility impairment) on a 1:2 basis. Results Of the 10,964 survivors invited for the cohort study, data are available from 6619 survivors, either questionnaire-based only (n=4979), hormonal-based only (n=72), or both (n=1568). For the nested case-control study, a total of 450 cases and 882 controls are identified. Conclusions Results of both PanCareLIFE fertility studies will provide detailed insight into the risk of fertility impairment following CAYA cancer and diagnostic- or treatment-related factors associated with an increased risk. This will help clinicians to adequately counsel both girls and young women, who are about to start anticancer treatment, as well as adult female CAYA cancer survivors, concerning future parenthood and to timely refer them for fertility preservation. Ultimately, we aim to empower patients and survivors and improve their quality of life. Registered Report Identifier RR1-10.2196/10824
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Affiliation(s)
- Marleen van den Berg
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Marloes van Dijk
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - Claire Berger
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Anja Borgmann-Staudt
- Division of Oncology and Hematology, Department of Pediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele Calaminus
- University Children's Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre, German Cancer Research Centre, Essen, Germany
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
| | | | - Desiree Grabow
- German Childhood Cancer Registry, Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Melanie Kaiser
- German Childhood Cancer Registry, Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Tomas Kepak
- International Clinical Research Center of St Anne's University Hospital Brno, Brno, Czech Republic
| | - Leontien C Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, University of Bern, Bern, Switzerland
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Alison Leiper
- Great Ormond Street Children's Hospital, London, United Kingdom
| | - Dalit Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Claudia Spix
- German Childhood Cancer Registry, Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
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Steliarova-Foucher E, Fidler MM, Colombet M, Lacour B, Kaatsch P, Piñeros M, Soerjomataram I, Bray F, Coebergh JW, Peris-Bonet R, Stiller CA. Changing geographical patterns and trends in cancer incidence in children and adolescents in Europe, 1991-2010 (Automated Childhood Cancer Information System): a population-based study. Lancet Oncol 2018; 19:1159-1169. [PMID: 30098952 PMCID: PMC6120055 DOI: 10.1016/s1470-2045(18)30423-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND A deceleration in the increase in cancer incidence in children and adolescents has been reported in several national and regional studies in Europe. Based on a large database representing 1·3 billion person-years over the period 1991-2010, we provide a consolidated report on cancer incidence trends at ages 0-19 years. METHODS We invited all population-based cancer registries operating in European countries to participate in this population-based registry study. We requested a listing of individual records of cancer cases, including sex, age, date of birth, date of cancer diagnosis, tumour sequence number, primary site, morphology, behaviour, and the most valid basis of diagnosis. We also requested population counts in each calendar year by sex and age for the registration area, from official national sources, and specific information about the covered area and registration practices. An eligible registry could become a contributor if it provided quality data for all complete calendar years in the period 1991-2010. Incidence rates and the average annual percentage change with 95% CIs were reported for all cancers and major diagnostic groups, by region and overall, separately for children (age 0-14 years) and adolescents (age 15-19 years). We examined and quantified the stability of the trends with joinpoint analyses. FINDINGS For the years 1991-2010, 53 registries in 19 countries contributed a total of 180 335 unique cases. We excluded 15 162 (8·4%) of 180 335 cases due to differing practices of registration, and considered the quality indicators for the 165 173 cases included to be satisfactory. The average annual age-standardised incidence was 137·5 (95% CI 136·7-138·3) per million person-years and incidence increased significantly by 0·54% (0·44-0·65) per year in children (age 0-14 years) with no change in trend. In adolescents, the combined European incidence was 176·2 (174·4-178·0) per million person-years based on all 35 138 eligible cases and increased significantly by 0·96% (0·73-1·19) per year, although recent changes in rates among adolescents suggest a deceleration in this increasing trend. We observed temporal variations in trends by age group, geographical region, and diagnostic group. The combined age-standardised incidence of leukaemia based on 48 458 cases in children was 46·9 (46·5-47·3) per million person-years and increased significantly by 0·66% (0·48-0·84) per year. The average overall incidence of leukaemia in adolescents was 23·6 (22·9-24·3) per million person-years, based on 4702 cases, and the average annual change was 0·93% (0·49-1·37). We also observed increasing incidence of lymphoma in adolescents (average annual change 1·04% [0·65-1·44], malignant CNS tumours in children (average annual change 0·49% [0·20-0·77]), and other tumours in both children (average annual change 0·56 [0·40-0·72]) and adolescents (average annual change 1·17 [0·82-1·53]). INTERPRETATION Improvements in the diagnosis and registration of cancers over time could partly explain the observed increase in incidence, although some changes in underlying putative risk factors cannot be excluded. Cancer incidence trends in this young population require continued monitoring at an international level. FUNDING Federal Ministry of Health of the Federal German Government, the European Union's Seventh Framework Programme, and International Agency for Research on Cancer.
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Affiliation(s)
- Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Miranda M Fidler
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Murielle Colombet
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Brigitte Lacour
- French National Registry of Childhood Solid Tumours, Centre Hospitalier Régional Universitaire, Nancy, France; Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris, France
| | - Peter Kaatsch
- German Childhood Cancer Registry, University Medical Center, Mainz, Germany
| | - Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Rafael Peris-Bonet
- Spanish Registry of Childhood Tumours (RETI-SEHOP), Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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Bright CJ, Hawkins MM, Winter DL, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Byrne J, Feijen EAM, Fidler MM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuehni CE, Linge H, Øfstaas H, Ronckers CM, Skinner R, Teepen JC, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuonen R, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Reulen RC. Risk of Soft-Tissue Sarcoma Among 69 460 Five-Year Survivors of Childhood Cancer in Europe. J Natl Cancer Inst 2018; 110:649-660. [PMID: 29165710 PMCID: PMC6005019 DOI: 10.1093/jnci/djx235] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/09/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Childhood cancer survivors are at risk of subsequent primary soft-tissue sarcomas (STS), but the risks of specific STS histological subtypes are unknown. We quantified the risk of STS histological subtypes after specific types of childhood cancer. Methods We pooled data from 13 European cohorts, yielding a cohort of 69 460 five-year survivors of childhood cancer. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated. Results Overall, 301 STS developed compared with 19 expected (SIR = 15.7, 95% confidence interval [CI] = 14.0 to 17.6). The highest standardized incidence ratios were for malignant peripheral nerve sheath tumors (MPNST; SIR = 40.6, 95% CI = 29.6 to 54.3), leiomyosarcomas (SIR = 29.9, 95% CI = 23.7 to 37.2), and fibromatous neoplasms (SIR = 12.3, 95% CI = 9.3 to 16.0). SIRs for MPNST were highest following central nervous system tumors (SIR = 80.5, 95% CI = 48.4 to 125.7), Hodgkin lymphoma (SIR = 81.3, 95% CI = 35.1 to 160.1), and Wilms tumor (SIR = 76.0, 95% CI = 27.9 to 165.4). Standardized incidence ratios for leiomyosarcoma were highest following retinoblastoma (SIR = 342.9, 95% CI = 245.0 to 466.9) and Wilms tumor (SIR = 74.2, 95% CI = 37.1 to 132.8). AERs for all STS subtypes were generally low at all years from diagnosis (AER < 1 per 10 000 person-years), except for leiomyosarcoma following retinoblastoma, for which the AER reached 52.7 (95% CI = 20.0 to 85.5) per 10 000 person-years among patients who had survived at least 45 years from diagnosis of retinoblastoma. Conclusions For the first time, we provide risk estimates of specific STS subtypes following childhood cancers and give evidence that risks of MPNSTs, leiomyosarcomas, and fibromatous neoplasms are particularly increased. While the multiplicative excess risks relative to the general population are substantial, the absolute excess risk of developing any STS subtype is low, except for leiomyosarcoma after retinoblastoma. These results are likely to be informative for both survivors and health care providers.
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Affiliation(s)
- Chloe J Bright
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Mike M Hawkins
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - David L Winter
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
| | | | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Miranda M Fidler
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Stanislaw Garwicz
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Childreńs Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Joyeeta Guha
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
| | - Nadia Haddy
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Momcilo Jankovic
- Foundation MBBM, Hemato-Oncology Center, University of Milano-Bicocca, Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Hilde Øfstaas
- Norwegian National Advisory Unit on Solid Tumors in Children, Oslo, Norway
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Roderick Skinner
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Jop C Teepen
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation Team, U1018 INSERM, Gustave Roussy, Villejuif, France
| | - Finn Wesenberg
- Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Wiebe
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Riccardo Haupt
- Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy
| | - Päivi Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | | | | | - Jeanette F Winther
- Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, the Netherlands
- Department of Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - Raoul C Reulen
- Center for Childhood Cancer Survivor Studies, Institute of Applied Health Research, Robert Aitken Building, University of Birmingham, Birmingham, UK
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Faber J, Wingerter A, Neu MA, Henninger N, Eckerle S, Münzel T, Lackner KJ, Beutel ME, Blettner M, Rathmann W, Peters A, Meisinger C, Linkohr B, Neuhauser H, Kaatsch P, Spix C, Schneider A, Merzenich H, Panova-Noeva M, Prochaska JH, Wild PS. Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy026] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- J Faber
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - A Wingerter
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - M A Neu
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - N Henninger
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - S Eckerle
- Department of Pediatric Hematology/Oncology/Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - T Münzel
- Center for Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
| | - K J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - M E Beutel
- Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - M Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - A Peters
- German Center for Cardiovascular Disease Research (DZHK), Partner Site Munich, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Pettenkoferstraße 9, 80336 Munich, Germany
| | - C Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - B Linkohr
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - H Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - A Schneider
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - H Merzenich
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
| | - M Panova-Noeva
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - J H Prochaska
- German Center for Cardiovascular Research (DZHK) Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - P S Wild
- German Center for Cardiovascular Research (DZHK) Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Centre for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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38
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Grabow D, Kaiser M, Hjorth L, Byrne J, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, de Vathaire F, Feijen EAM, Garwicz S, Hagberg O, Haupt R, Hawkins MM, Jakab Z, Kremer LCM, Kuehni CE, Kuonen R, Lähteenmäki PM, Reulen RC, Ronckers CM, Sacerdote C, Vu-Bezin G, Wesenberg F, Wiebe T, Winter DL, Winther JF, Zaletel LZ, Kaatsch P. The PanCareSurFup cohort of 83,333 five-year survivors of childhood cancer: a cohort from 12 European countries. Eur J Epidemiol 2018; 33:335-349. [PMID: 29497894 PMCID: PMC5889790 DOI: 10.1007/s10654-018-0370-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/15/2018] [Indexed: 11/30/2022]
Abstract
Childhood cancer survivors face risks from a variety of late effects, including cardiac events, second cancers, and late mortality. The aim of the pan-European PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) Consortium was to collect data on incidence and risk factors for these late effects among childhood cancer survivors in Europe. This paper describes the methodology of the data collection for the overall PanCareSurFup cohort and the outcome-related cohorts. In PanCareSurFup 13 data providers from 12 countries delivered data to the data centre in Mainz. Data providers used a single variable list that covered all three outcomes. After validity and plausibility checks data was provided to the outcome-specific working groups. In total, we collected data on 115,596 patients diagnosed with cancer from 1940 to 2011, of whom 83,333 had survived 5 years or more. Due to the eligibility criteria and other requirements different numbers of survivors were eligible for the analysis of each of the outcomes. Thus, 1014 patients with at least one cardiac event were identified from a cohort of 39,152 5-year survivors; for second cancers 3995 survivors developed at least one second cancer from a cohort of 71,494 individuals, and from the late mortality cohort of 79,441 who had survived at least 5 years, 9247 died subsequently. Through the close cooperation of many European countries and the establishment of one central data collection and harmonising centre, the project succeeded in generating the largest cohort of children with cancer to date.
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Affiliation(s)
- Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Melanie Kaiser
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lars Hjorth
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, Co. Louth, A92 RY6K, Ireland
| | - Daniela Alessi
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Rodrigue S Allodji
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Edit Bárdi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
- Kepler Universitätsklinikum, Linz, Austria
| | - Andrea Bautz
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Florent de Vathaire
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | | | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Gaslini Children's Hospital, Via Gerolamo Gaslini, 5, 16148, Genova, Italy
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Päivi Maria Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Giao Vu-Bezin
- Cancer and Radiation, Unit 1018 INSERM, University Paris-Saclay, Gustave Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France
| | - Finn Wesenberg
- Norwegian Cancer Register Department of Pediatric Medicine, Faculty of Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Wiebe
- Department of Clinical Sciences, Skane University Hospital, Lund University, Pediatrics, Lund, Sweden
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Dantonello TM, Vokuhl C, Scheer M, Sparber-Sauer M, Stegmaier S, Seitz G, Scheithauer H, Faber J, Veit-Friedrich I, Kaatsch P, Bielack SS, Klingebiel T, Koscielniak E. Paratesticular alveolar rhabdomyosarcomas do not harbor typical translocations: a distinct entity with favorable prognosis? Virchows Arch 2018; 472:441-449. [DOI: 10.1007/s00428-018-2311-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/05/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
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Abstract
AbstractThe registry of childhood malignancies in the F.R.G. is a combination of a population-based and hospital-based cancer registry. A large amount of the collected data originates from multicenter clinical trials which are integrated into the documentation system of the cancer registry. The paper describes the information flow and the system of data storage which consists of a central database on a departmental system at the registry and of several coordinated peripheral databases on microcomputers at the trial centers. Practical experience shows an increased availability and validity of the data in the registry since the implementation of the system. Aspects of data integrity and security are discussed. Although the system was designed according to specific demands of the registry, it may serve as a model for similar tasks of cooperative documentation and information exchange.
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Abstract
The debate surrounding possible adverse health effects from the civil use of nuclear power under normal operating conditions has been on-going since its introduction. It was particularly intensified by the detection of three leukaemia clusters near nuclear installations, i.e. near the reprocessing plants in Sellafield and Dounreay, UK, and near the Krümmel nuclear power plant, Germany, the last of which commenced between 1990 and 1991 and was first described in 1992; it continued until 2003, and an elevated risk up to 2005 has been reported in the literature. A number of expert commissions and working groups were set up by the governments of the German federal states of Lower Saxony and Schleswig-Holstein to investigate the possible causes of the cluster. An overview of the many risk factors that were investigated as a possible explanation of the Krümmel cluster is given here, focussing on radiation, but also including other risk factors. Further, results from related epidemiological and cytogenetic studies are described. In summary, the cause of the occurrence of the Krümmel cluster has to be considered as unknown. Further research on the causes of childhood leukaemia is needed, focussing on epigenetics and on gene-environment interaction. An update of the leukaemia incidence around the Krümmel site shows that the incidence rates are now comparable to the average rate in Germany.
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Affiliation(s)
- B Grosche
- Freising, Germany (retired, formerly Federal Office for Radiation Protection, Oberschleissheim, Germany
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42
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Petersen I, Kaatsch P, Spix C, Kollek R. Return and Disclosure of Research Results: Parental Attitudes and Needs Over Time in Pediatric Oncology. J Pediatr 2017; 191:232-237. [PMID: 28969889 DOI: 10.1016/j.jpeds.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/22/2017] [Accepted: 08/03/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore parental attitudes regarding the return and disclosure of research findings in pediatric cancer trials over time. STUDY DESIGN Two surveys were set up to evaluate the stability of parental attitudes. One survey was carried out among 581 parents whose child was diagnosed recently (response rate, 53.5%). A second, population-based survey was set up with a time interval of 4 years between first cancer diagnosis and survey in which 1465 parents were included (response rate, 55.1%). RESULTS Almost all surveyed parents stated a parental right to receive aggregate research results. Fifty-five percent of the parents who recently participated in trials and 62% of those asked after a multiyear time interval thought that disclosure of individual findings is in any case necessary (P = .0034). The respondents wanted to restrict the duty to disclose study results to the child according to their notion of the child's well-being, composed of child's maturity, impairment of the parent-child relationship, and the quality of the results. CONCLUSIONS Attitudes of parents regarding the return of research findings change over time. Shortly after diagnosis, parents are mainly interested in aggregate findings. Interest in individual findings appeared to increase as more time elapsed between cancer diagnosis and survey.
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Affiliation(s)
- Imme Petersen
- Hamburg University, Research Centre for Biotechnology, Society and the Environment, Research Group on Medicine and Neurosciences, Hamburg, Germany.
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Regine Kollek
- Hamburg University, Research Centre for Biotechnology, Society and the Environment, Research Group on Medicine and Neurosciences, Hamburg, Germany
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43
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Fidler MM, Reulen RC, Winter DL, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, Byrne J, Feijen EAM, Garwicz S, Grabow D, Gudmundsdottir T, Guha J, Haddy N, Jankovic M, Kaatsch P, Kaiser M, Kuonen R, Linge H, Maule M, Merletti F, Øfstaas H, Ronckers CM, Skinner R, Teepen J, Terenziani M, Vu-Bezin G, Wesenberg F, Wiebe T, Jakab Z, Haupt R, Lähteenmäki P, Zaletel LZ, Kuehni CE, Winther JF, de Vathaire F, Kremer LC, Hjorth L, Hawkins MM. Risk of Subsequent Bone Cancers Among 69 460 Five-Year Survivors of Childhood and Adolescent Cancer in Europe. J Natl Cancer Inst 2017; 110:4237499. [PMID: 28954302 DOI: 10.1093/jnci/djx165] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/19/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction We investigate the risks of subsequent primary bone cancers after childhood and adolescent cancer in 12 European countries. For the first time, we satisfactorily address the risks beyond 40 years from diagnosis and beyond 40 years of age among all survivors. Methods This largest-ever assembled cohort comprises 69 460 five-year survivors of cancer diagnosed before age 20 years. Standardized incidence ratios, absolute excess risks, and multivariable-adjusted relative risks and relative excess risks were calculated. All statistical tests were two-sided. Results Overall, survivors were 21.65 times (95% confidence interval = 18.97 to 24.60 times) more likely to be diagnosed with a subsequent primary bone cancer than expected from the general population. The greatest excess numbers of bone cancers were observed after retinoblastoma, bone sarcoma, and soft tissue sarcoma. The excess number of bone cancers declined linearly with both years since diagnosis and attained age (all P < .05). Beyond 40 years from diagnosis and age 40 years, there were at most 0.45 excess bone cancers among all survivors per 10 000 person-years at risk; beyond 30 years from diagnosis and age 30 years, there were at most 5.02 excess bone cancers after each of retinoblastoma, bone sarcoma, and soft tissue sarcoma, per 10 000 person-years at risk. Conclusions For all survivors combined and the cancer groups with the greatest excess number of bone cancers, the excess numbers observed declined with both age and years from diagnosis. These results provide novel, reliable, and unbiased information about risks and risk factors among long-term survivors of childhood and adolescent cancer.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rodrigue S Allodji
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Francesca Bagnasco
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Edit Bárdi
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Andrea Bautz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Julianne Byrne
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Elizabeth A M Feijen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Stanislaw Garwicz
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Desiree Grabow
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thorgerdur Gudmundsdottir
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Joyeeta Guha
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nadia Haddy
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Momcilo Jankovic
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Peter Kaatsch
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Melanie Kaiser
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helena Linge
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Milena Maule
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Franco Merletti
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Hilde Øfstaas
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Cecile M Ronckers
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Roderick Skinner
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jop Teepen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Monica Terenziani
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Giao Vu-Bezin
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Finn Wesenberg
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thomas Wiebe
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Zsuzsanna Jakab
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Riccardo Haupt
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Päivi Lähteenmäki
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lorna Zadravec Zaletel
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jeanette F Winther
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florent de Vathaire
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Leontien C Kremer
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lars Hjorth
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Cancer and Radiation Team, U1018 INSERM, Villejuif, France; Epidemiology and Biostatistics Section, Gaslini Children Hospital, Genova, Italy; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria; Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark; Boyne Research Institute, Drogheda, Ireland; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland; Pediatric Hematology Unit, San Gerardo Hospital, Monza, Italy; Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Torino, Italy; Norwegian National Advisory Unit on Solid Tumors in Children; Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK; Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland; Institute of Oncology, Ljubljana, Slovenia; Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
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Gatta G, Peris-Bonet R, Visser O, Stiller C, Marcos-Gragera R, Sánchez MJ, Lacour B, Kaatsch P, Berrino F, Rutkowski S, Botta L, Hackl M, Zielonke N, Oberaigner W, Van Eycken E, Henau K, Valerianova Z, Dimitrova N, Sekerija M, Storm H, Engholm G, Mägi M, Aareleid T, Malila N, Seppä K, Faivre J, Bossard N, Uhry Z, Colonna M, Clavel J, Lacour B, Desandes E, Brenner H, Kaatsch P, Katalinic A, Garami M, Jakab Z, Comber H, Mazzoleni G, Bulatko A, Buzzoni C, Giacomin A, Sutera Sardo A, Mancuso P, Ferretti S, Barchielli A, Caldarella A, Gatta G, Sant M, Amash H, Amati C, Baili P, Berrino F, Bonfarnuzzo S, Botta L, Capocaccia R, Di Salvo F, Foschi R, Margutti C, Meneghini E, Minicozzi P, Trama A, Serraino D, Zucchetto A, De Angelis R, Caldora M, Carrani E, Francisci S, Mallone S, Pierannunzio D, Roazzi P, Rossi S, Santaquilani M, Tavilla A, Pannozzo F, Busco S, Filiberti R, Marani E, Ricci P, Pascucci C, Autelitano M, Spagnoli G, Cirilli C, Fusco M, Vitale M, Usala M, Vitale F, Ravazzolo B, Michiara M, Merletti F, Maule M, Tumino R, Mangone L, Di Felice E, Falcini F, Iannelli A, Sechi O, Cesaraccio R, Piffer S, Madeddu A, Tisano F, Maspero S, Fanetti A, Candela P, Scuderi T, Stracci F, Bianconi F, Tagliabue G, Contiero P, Rugge M, Guzzinati S, Pildava S, Smailyte G, Calleja N, Agius D, Johannesen T, Rachtan J, Góźdź S, Mężyk R, Błaszczyk J, Bębenek M, Bielska-Lasota M, Forjaz de Lacerda G, Bento M, Castro C, Miranda A, Mayer-da-Silva A, Safaei Diba C, Primic-Zakelj M, Errezola M, Bidaurrazaga J, Vicente Raneda M, Díaz García J, Marcos-Navarro A, Marcos-Gragera R, Izquierdo Font A, Sanchez M, Chang D, Navarro C, Chirlaque M, Moreno-Iribas C, Ardanaz E, Peris-Bonet R, Pardo Romaguera E, Galceran J, Carulla M, Lambe M, Mousavi M, Bouchardy C, Usel M, Ess S, Frick H, Lorez M, Herrmann C, Bordoni A, Spitale A, Konzelmann I, Visser O, Aarts M, Otter R, Coleman M, Allemani C, Rachet B, Verne J, Stiller C, Gavin A, Donnelly C, Brewster D. Geographical variability in survival of European children with central nervous system tumours. Eur J Cancer 2017; 82:137-148. [DOI: 10.1016/j.ejca.2017.05.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/28/2022]
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Marron M, Zahnreich S, Sinizyn O, Schmidberger H, Hess M, Dadras PS, Altebockwinkel I, Hankeln T, Rapp S, Ebersberger A, Grad C, Holzhäuser E, Eckhard L, Proschek D, Blettner M, Kaatsch P, Spix C, Galetzka D, Binder H. Abstract 4261: Cancer in childhood and molecular epidemiology - The KIKME case-control study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Treatment of first primary neoplasms (PN) in childhood with radiotherapy or chemotherapy is an established risk factor for second primary neoplasms (SN). In addition, there is growing evidence for this association from observational studies on ionizing radiation and cancer risk, in particular after radiation exposure in childhood. As only a subgroup of the treated children suffers from SN, other risk modifying factors (e.g. genetics) must be involved. We are conducting a case-control study with 600 anticipated participants to evaluate gene-radiation interactions and risk of SN (leukemia, thyroid or skin cancer) as well as PN (leukemia, lymphoma or CNS) with a new epidemiological design, in which we combine observational with experimental elements by analyzing gene expression in irradiated cultured human fibroblasts from skin biopsies.
In a first step, we examine the participation proportions of survivors of childhood cancer with and without a SN and cancer free control patients (CO) from the department of accident surgery and orthopaedics. In addition to a skin biopsy of 3 mm and a saliva sample, we collect detailed questionnaire information on lifetime exposure to medical radiation and chemotherapy, socio-demographic factors, smoking, drinking, physical activity, medical history and family history of cancer and other diseases. Cases and controls will be matched by sex and age (1:1), and additionally among the former childhood cancer patients by type of the PN and year of first diagnosis (1 SN:3 PN). In explorative pilot experiments, we estimate gene expression differences by RNA-Seq in fibroblasts after low (0.05 Gy) and high (2 Gy) radiation doses at different time points (0.25 h, 2 h, 24 h).
In the first recruitment drives of the ongoing study, we recruited 77 patients with SN and 95 matched patients with only one PN from 1975 eligible former childhood cancer patients at the German Childhood Cancer Registry, as well as 22 CO patients. Until November 2016, 33% of the contacted 231 SN patients, 20% of the 486 contacted PN patients and 69% of the 32 contacted CO patients participated in our study. Two hours after low and high in vitro radiation doses, the largest number of genes were differentially expressed, some of them only after high doses, some only after low doses and some after both.
To our knowledge, the KIKME study is the first epidemiological project analyzing differential gene expression in primary fibroblasts before and after radiation with high and low doses to evaluate the potential genetic basis for emergence of a SN and a PN. However, the biological importance of the suggested differential gene expression after high and low doses of radiation has to be confirmed with the full study population. In addition, the gene expression must be analyzed in detail by group (SN, PN, CO) and will be combined with results from whole genome sequencing in order to obtain a comprehensive view of the role of radiation in the carcinogenesis of childhood cancer.
Citation Format: Manuela Marron, Sebastian Zahnreich, Olesja Sinizyn, Heinz Schmidberger, Moritz Hess, Patricia Sadre Dadras, Iris Altebockwinkel, Thomas Hankeln, Steffen Rapp, Anne Ebersberger, Christian Grad, Eva Holzhäuser, Lukas Eckhard, Dirk Proschek, Maria Blettner, Peter Kaatsch, Claudia Spix, Danuta Galetzka, Harald Binder. Cancer in childhood and molecular epidemiology - The KIKME case-control study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4261. doi:10.1158/1538-7445.AM2017-4261
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Affiliation(s)
- Manuela Marron
- 1Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Sebastian Zahnreich
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Olesja Sinizyn
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Moritz Hess
- 3Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | - Iris Altebockwinkel
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Hankeln
- 4Institute of Molecular Genetics, Johannes Gutenberg University, Mainz, Germany
| | - Steffen Rapp
- 4Institute of Molecular Genetics, Johannes Gutenberg University, Mainz, Germany
| | - Anne Ebersberger
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Grad
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Eva Holzhäuser
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Lukas Eckhard
- 5Department of Orthopaedic Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dirk Proschek
- 5Department of Orthopaedic Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- 3Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter Kaatsch
- 6German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Claudia Spix
- 6German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Danuta Galetzka
- 2Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Harald Binder
- 3Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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46
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Spix C, Grosche B, Bleher M, Kaatsch P, Scholz-Kreisel P, Blettner M. Background gamma radiation and childhood cancer in Germany: an ecological study. Radiat Environ Biophys 2017; 56:127-138. [PMID: 28337585 DOI: 10.1007/s00411-017-0689-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
The relationship of low-dose background gamma radiation and childhood leukaemia was investigated in a number of studies. Results from these studies are inconclusive. Therefore, in the present study 25 years of German childhood cancer data were analyzed using interpolated background annual gamma dose rate per community in an ecological study. The main question was leukaemia; as exploratory questions we investigate central nervous system (CNS) tumours, thyroid carcinomas and diagnoses less likely to be related to radiation. A Poisson regression model was applied and a fractional polynomial model building procedure. As the main sensitivity analysis a community deprivation index was included as a potential confounder. It was found that outdoor background gamma annual dose rates in Germany range roughly from 0.5-1.5 mSv/a with an average of 0.817 mSv/a. No association of annual ambient gamma dose rates with leukaemia incidence was found. Amongst the exploratory analyses, a strong association was found with CNS tumour incidence [rate ratio for 1.5 vs 0.5 mSv/a: 1.35; 95% confidence interval (1.17, 1.57)]. The community level deprivation index was not a confounder. It is concluded that the present study did not confirm an association of annual outdoor ambient gamma dose rate and childhood leukaemia, corresponding to some studies and contrasting others. An association with CNS incidence was found in the exploratory analyses. As this is an ecological study no causal interpretation is possible.
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Affiliation(s)
- Claudia Spix
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany.
| | - Bernd Grosche
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Martin Bleher
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Peter Scholz-Kreisel
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Maria Blettner
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
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47
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Ripperger T, Bielack SS, Borkhardt A, Brecht IB, Burkhardt B, Calaminus G, Debatin KM, Deubzer H, Dirksen U, Eckert C, Eggert A, Erlacher M, Fleischhack G, Frühwald MC, Gnekow A, Goehring G, Graf N, Hanenberg H, Hauer J, Hero B, Hettmer S, von Hoff K, Horstmann M, Hoyer J, Illig T, Kaatsch P, Kappler R, Kerl K, Klingebiel T, Kontny U, Kordes U, Körholz D, Koscielniak E, Kramm CM, Kuhlen M, Kulozik AE, Lamottke B, Leuschner I, Lohmann DR, Meinhardt A, Metzler M, Meyer LH, Moser O, Nathrath M, Niemeyer CM, Nustede R, Pajtler KW, Paret C, Rasche M, Reinhardt D, Rieß O, Russo A, Rutkowski S, Schlegelberger B, Schneider D, Schneppenheim R, Schrappe M, Schroeder C, von Schweinitz D, Simon T, Sparber-Sauer M, Spix C, Stanulla M, Steinemann D, Strahm B, Temming P, Thomay K, von Bueren AO, Vorwerk P, Witt O, Wlodarski M, Wössmann W, Zenker M, Zimmermann S, Pfister SM, Kratz CP. Childhood cancer predisposition syndromes-A concise review and recommendations by the Cancer Predisposition Working Group of the Society for Pediatric Oncology and Hematology. Am J Med Genet A 2017; 173:1017-1037. [PMID: 28168833 DOI: 10.1002/ajmg.a.38142] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 12/12/2022]
Abstract
Heritable predisposition is an important cause of cancer in children and adolescents. Although a large number of cancer predisposition genes and their associated syndromes and malignancies have already been described, it appears likely that there are more pediatric cancer patients in whom heritable cancer predisposition syndromes have yet to be recognized. In a consensus meeting in the beginning of 2016, we convened experts in Human Genetics and Pediatric Hematology/Oncology to review the available data, to categorize the large amount of information, and to develop recommendations regarding when a cancer predisposition syndrome should be suspected in a young oncology patient. This review summarizes the current knowledge of cancer predisposition syndromes in pediatric oncology and provides essential information on clinical situations in which a childhood cancer predisposition syndrome should be suspected.
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Affiliation(s)
- Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Stefan S Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Arndt Borkhardt
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Ines B Brecht
- General Pediatrics, Hematology/Oncology, University Children's Hospital Tuebingen, Tuebingen, Germany.,Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Hedwig Deubzer
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Uta Dirksen
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Cornelia Eckert
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Miriam Erlacher
- Faculty of Medicine, Division of Pediatric Hematology and Oncology Medical Center, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Gudrun Fleischhack
- Pediatric Oncology and Hematology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Michael C Frühwald
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Astrid Gnekow
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Gudrun Goehring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Helmut Hanenberg
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany.,Department of Otorhinolaryngology and Head/Neck Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Julia Hauer
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Barbara Hero
- Department of Pediatric Hematology and Oncology, University of Cologne, Cologne, Germany
| | - Simone Hettmer
- Faculty of Medicine, Division of Pediatric Hematology and Oncology Medical Center, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Horstmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Illig
- Department of Human Genetics, Hannover Medical School, Hannover, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Roland Kappler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Kornelius Kerl
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Thomas Klingebiel
- Hospital for Children and Adolescents, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Udo Kontny
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Aachen, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus Liebig University, Giessen, Germany
| | - Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Michaela Kuhlen
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Britta Lamottke
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Ivo Leuschner
- Kiel Paediatric Tumor Registry, Department of Paediatric Pathology, University of Kiel, Kiel, Germany
| | - Dietmar R Lohmann
- Institute of Human Genetics, University Hospital Essen, Essen, Germany.,Eye Oncogenetics Research Group, University Hospital Essen, Essen, Germany
| | - Andrea Meinhardt
- Department of Pediatric Hematology and Oncology, Justus Liebig University, Giessen, Germany
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lüder H Meyer
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Olga Moser
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Aachen, Germany
| | - Michaela Nathrath
- Department of Pediatric Oncology, Klinikum Kassel, Kassel, Germany.,Clinical Cooperation Group Osteosarcoma, Helmholtz Zentrum Munich, Neuherberg, Germany.,Pediatric Oncology Center, Technical University Munich, Munich, Germany
| | - Charlotte M Niemeyer
- Faculty of Medicine, Division of Pediatric Hematology and Oncology Medical Center, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Nustede
- Department of Surgery, Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Kristian W Pajtler
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Paret
- Department of Pediatric Hematology/Oncology, University Medical Center Mainz, Mainz, Germany
| | - Mareike Rasche
- Pediatric Oncology and Hematology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Dirk Reinhardt
- Pediatric Oncology and Hematology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Olaf Rieß
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Alexandra Russo
- Department of Pediatric Hematology/Oncology, University Medical Center Mainz, Mainz, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Schrappe
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Thorsten Simon
- Department of Pediatric Hematology and Oncology, University of Cologne, Cologne, Germany
| | - Monika Sparber-Sauer
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Claudia Spix
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Stanulla
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Doris Steinemann
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Brigitte Strahm
- Faculty of Medicine, Division of Pediatric Hematology and Oncology Medical Center, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Petra Temming
- Pediatric Oncology and Hematology, Pediatrics III, University Hospital of Essen, Essen, Germany.,Eye Oncogenetics Research Group, University Hospital Essen, Essen, Germany
| | - Kathrin Thomay
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Andre O von Bueren
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany.,Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Peter Vorwerk
- Pediatric Oncology, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Olaf Witt
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcin Wlodarski
- Faculty of Medicine, Division of Pediatric Hematology and Oncology Medical Center, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Willy Wössmann
- Department of Pediatric Hematology and Oncology, Justus Liebig University, Giessen, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanie Zimmermann
- Hospital for Children and Adolescents, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Stefan M Pfister
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
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48
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Abstract
BACKGROUND A comprehensive clinical long-term survey over the complete spectrum of neuroblatoma disease is lacking in the literature. OBJECTIVE Our objective was to describe the incidence, risk profiles, therapies, and outcomes for the total cohort of German patients with neuroblastoma including all clinical stages and risk groups. METHODS Epidemiological, clinical, and outcome data of neuroblastoma patients who participated in one of the six consecutive national trials between 1979 and 2015 were analyzed retrospectively. RESULTS Of all German neuroblastoma patients known to the national childhood cancer registry, ninety seven percent enrolled in one of the trials. The absolute neuroblastoma rate has increased slightly, whereas the median age at diagnosis has decreased. Except for the screening period (1995-2000), the risk factors lactate dehydrogenase (LDH), ferritin, chromosome 1p, and the MYCN oncogene have remained largely constant, with the exception of an increase in MYCN amplification at stage 4 for those aged ≥18 months between trials NB97 (27%) and NB2004 (35%). The 10-year overall survival increased in patients with stage 1-3 neuroblastoma from 83 to 91%, for stage 4S from 80 to 85%, and for stage 4 aged ≥18 months from 2 to 38%. The fraction of patients in stages 1-3 who never received chemotherapy (neither for frontline nor at recurrence) increased from 35 to 60%. The proportion of macroscopically complete surgical resections of the primary tumor decreased for the total population as well as for patients with stage 4 aged ≥18 months. The impact of chemotherapy response on the outcome was trial dependent. The overall proportion of toxic death during the time of the protocol therapy was 6% for stage 4 patients aged ≥18 months and 2% for low-/intermediate-risk patients. The most frequently reported late sequelae in stage 4 patients aged ≥18 months were renal dysfunctions, hypothyroidism, major hearing impairment, and second malignancies. CONCLUSION The body of data for incidences, risk profiles, and survival rates from this survey of more than 37 years provides a useful perspective for future studies on neuroblastoma sub-cohorts.
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Affiliation(s)
- Frank Berthold
- Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Claudia Spix
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Peter Kaatsch
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Fritz Lampert
- 0000 0001 2165 8627grid.8664.cDepartment of Pediatric Oncology and Hematology, Children’s Hospital, University of Giessen, Giessen, Germany
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49
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Zuzak TJ, Kameda G, Schütze T, Kaatsch P, Seifert G, Bailey R, Längler A. Contributing factors and outcomes of treatment refusal in pediatric oncology in Germany. Pediatr Blood Cancer 2016; 63:1800-5. [PMID: 27348500 DOI: 10.1002/pbc.26111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Germany, about 1,800 new cases of pediatric cancer under 15 years of age are diagnosed each year and survival rates approach 80%. Although treatment is covered by health insurance and is thus available for all patients at no cost, treatment refusal and treatment discontinuation have been observed. However, no data providing numbers and outcomes for developed countries have been published thus far. PROCEDURE A questionnaire-based survey was performed among German pediatric oncology centers to ascertain the number of treatment refusals among pediatric patients who were diagnosed between January 2008 and December 2009 in Germany. RESULTS Questionnaires from 70 of 73 centers were available, and of these 13 centers reported a total of 15 cases of treatment refusal or discontinuation within this 2-year period. Five of the 15 patients died, 7 of 15 were still alive, and the current status of 3 of 15 patients was unknown. Diseases were heterogeneous. Six of the 15 parents refused treatment for their children initially, 8 of 15 discontinued during the course of treatment. Five patients were treated after parental custody had been withdrawn due to the lack of compliance. All these five patients survived. Parents' reasons given for refusal or discontinuation of treatment were related to personal health beliefs and coping strategies. CONCLUSIONS Although treatment refusal or discontinuation is rare, it is accompanied by a high mortality rate. Parents' personal health beliefs play a primary role in treatment refusal or discontinuation in Germany. This emphasizes the importance of sustaining a functioning and mutually communicative physician-parent-patient relationship.
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Affiliation(s)
- Tycho Jan Zuzak
- Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Germany.,Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Germany
| | - Genn Kameda
- Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Tim Schütze
- Faculty of Health, Professorship for Integrative Pediatrics Centre for Integrative Medicine, University of Witten/Herdecke, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Georg Seifert
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rebekka Bailey
- Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Germany.,Faculty of Health, Professorship for Integrative Pediatrics Centre for Integrative Medicine, University of Witten/Herdecke, Germany
| | - Alfred Längler
- Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Germany.,Faculty of Health, Professorship for Integrative Pediatrics Centre for Integrative Medicine, University of Witten/Herdecke, Germany
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50
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Kaatsch P, Strothotte J, Becker C, Bielack S, Dirksen U, Blettner M. Pediatric bone tumors in Germany from 1987 to 2011: incidence rates, time trends and survival. Acta Oncol 2016; 55:1145-1151. [PMID: 27549334 DOI: 10.1080/0284186x.2016.1195509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Malignant bone tumors are a rare group of childhood cancer. MATERIALS AND METHODS This study describes incidence rates, survival probabilities, and time trends for 1831 children below 15 years of age with a bone tumor registered at the population-based German Childhood Cancer Registry between 1987 and 2011. RESULTS Overall age-standardized annual incidence rate (ASR) was 5.5 per million. Osteosarcomas (ASR 2.8) and Ewing tumors (ASR 2.6) were the most frequent diagnostic groups. The incidence of bone tumors overall tended to increase slightly over time by 0.7% each year on average. Thirty-nine of the bone tumor cases reported were subsequent primaries and not included into the survival analysis. Survival probabilities remained largely constant. DISCUSSION Possibly survival was largely constant because chemotherapy has not changed much over time. Overall, the results are similar to other results reported from Europe.
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Affiliation(s)
- Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jill Strothotte
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cornelia Becker
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart – Olgahospital, Stuttgart, Germany
| | - Uta Dirksen
- Paediatric Haematology and Oncology, University Children’s Hospital Muenster, Muenster, Germany
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
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