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Gueiderikh A, Sarrade T, Kirova Y, De La Lande B, De Vathaire F, Auzac G, Martin AL, Everhard S, Meillan N, Bourgier C, Benyoucef A, Lacornerie T, Pasquier D, Racadot S, Moignier A, Paris F, André F, Deutsch E, Duchemann B, Allodji RS, Rivera S. Radiation-induced lung injury after breast cancer treatment: incidence in the CANTO-RT cohort and associated clinical and dosimetric risk factors. Front Oncol 2023; 13:1199043. [PMID: 37456251 PMCID: PMC10342531 DOI: 10.3389/fonc.2023.1199043] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Radiation-induced lung injury (RILI) is strongly associated with various clinical conditions and dosimetric parameters. Former studies have led to reducing radiotherapy (RT) doses to the lung and have favored the discontinuation of tamoxifen during RT. However, the monocentric design and variability of dosimetric parameters chosen have limited further improvement. The aim of our study was to assess the incidence of RILI in current practice and to determine clinical and dosimetric risk factors associated with RILI occurrence. Material and methods Data from 3 out of the 10 top recruiting centers in CANTO-RT, a subset of the CANTO prospective longitudinal cohort (NCT01993498), were retrospectively analyzed for RILI occurrence. This cohort, which recruited invasive cT0-3 cN0-3 M0 breast cancer patients from 2012 to 2018, prospectively recorded the occurrence of adverse events by questionnaires and medical visits at the end of, and up to 60 months after treatment. RILI adverse events were defined in all patients by the association of clinical symptoms and compatible medical imaging. Results RILI was found in 38/1565 (2.4%) patients. Grade II RILI represented 15/38 events (39%) and grade III or IV 2/38 events (6%). There were no grade V events. The most frequently used technique for treatment was 3D conformational RT (96%). In univariable analyses, we confirmed the association of RILI occurrence with pulmonary medical history, absence of cardiovascular disease medical history, high pT and pN, chemotherapy use, nodal RT. All dosimetric parameters were highly correlated and had close predictive value. In the multivariable analysis adjusted for chemotherapy use and nodal involvement, pulmonary medical history (OR=3.05, p<0.01) and high V30 Gy (OR=1.06, p=0.04) remained statistically significant risk factors for RILI occurrence. V30 Gy >15% was significantly associated with RILI occurrence in a multivariable analysis (OR=3.07, p=0.03). Conclusion Our study confirms the pulmonary safety of breast 3D RT in CANTO-RT. Further analyses with modern radiation therapy techniques such as IMRT are needed. Our results argue in favor of a dose constraint to the ipsilateral lung using V30 Gy not exceeding 15%, especially in patients presenting pulmonary medical history. Pulmonary disease records should be taken into account for RT planning.
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Affiliation(s)
- Anna Gueiderikh
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
- University Versailles, St. Quentin, France
| | | | - Florent De Vathaire
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Guillaume Auzac
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | | | - Nicolas Meillan
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
- Radiation Therapy Department, CH Victor Dupouy, Argenteuil, France
| | - Celine Bourgier
- Montpellier University, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1194, Montpellier, France
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Ahmed Benyoucef
- Radiation Therapy Department, Henri Becquerel Center, Rouen, France
| | - Thomas Lacornerie
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
| | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
- Univ. Lille, &, Centre National de la Recherche Scientifique (CNRS), Centrale Lille, Unité Mixte de Recherche (UMR) 9189 – Centre de Recherche en Informatique, Signal et Automatique de Lille (CRIStAL), Lille, France
| | | | - Alexandra Moignier
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
| | - François Paris
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
- Nantes Université, Nantes - Angers Cancer and Immunology Research Center (CRCI2NA), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Nantes, France
| | - Fabrice André
- Gustave Roussy, Medical Oncology Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) U981, Villejuif, France
| | - Eric Deutsch
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
| | | | - Rodrigue Setcheou Allodji
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Sofia Rivera
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
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Chounta S, Lemler S, Haddy N, Fresneau B, Mansouri I, Bentriou M, Demoor-Goldschmidt C, Diallo I, Souchard V, Do TD, Veres C, Surun A, Doz F, Llanas D, Vu-Bezin G, Rubino C, de Vathaire F, Letort V, Allodji RS. The risk of valvular heart disease in the French Childhood Cancer Survivors' Study: Contribution of dose-volume histogram parameters. Radiother Oncol 2023; 180:109479. [PMID: 36657724 DOI: 10.1016/j.radonc.2023.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Valvular Heart Disease (VHD) is a known complication of childhood cancer after radiotherapy treatment. However, the dose-volume-effect relationships have not been fully explored. MATERIALS AND METHODS We obtained individual heart Dose Volume Histograms (DVH) for survivors of the French Childhood Cancer Survivors Study (FCCSS) who had received radiotherapy. We calculated the Mean Dose to the Heart (MHD) in Gy, as well as the heart DVH parameters (Vd Gy, which represents the percentage of heart volume receiving at least d Gy), fixing the thresholds to 0.1 Gy, 5 Gy, 20 Gy, and 40 Gy. We analyzed them furtherly in the subpopulation of the cohort that was treated with a dose lower than 5 Gy (V0.1Gy|V5Gy=0%), 20 Gy (V5Gy|V20Gy=0%), and 40 Gy (V20Gy|V40Gy=0%), respectively. We investigated their role in the occurrence of a VHD in this population-based observational cohort study using the Cox proportional hazard model, adjusting for age at cancer diagnosis and chemotherapy exposure. RESULTS Median follow-up was 30.6 years. Eighty-one patients out of the 7462 (1 %) with complete data experienced a severe VHD (grade ≥ 3). The risk of VHD increased along with the MHD, and it was associated with high doses to the heart (V40Gy < 50 %, hazard ratio (HR) = 7.96, 95 % CI: 4.26-14.88 and V20Gy|V40Gy=0% >50 %, HR = 5.03, 95 % CI: [2.35-10.76]). Doses 5-20 Gy to more than 50 % (V5Gy|V20Gy=0% >50 %) of the heart induced a marginally non-significant estimated risk. We also observed a remarkable risk increase with attained age. CONCLUSIONS Our results provide new insight into the VHD risk that may impact current treatments and long-term follow-up of childhood cancer survivors.
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Affiliation(s)
- Stefania Chounta
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Sarah Lemler
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Nadia Haddy
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric oncology, Villejuif, F-94805, France
| | - Imene Mansouri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; EPI-PHARE Scientific Interest Group, Saint-Denis, France; French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | - Mahmoud Bentriou
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Charlotte Demoor-Goldschmidt
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Chu de Nantes, Pediatric Oncology, 38 Bd Jean Monnet, Nantes 44093, France
| | - Ibrahima Diallo
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Vincent Souchard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Thi-Duyen Do
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Cristina Veres
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Aurore Surun
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France; Université Paris Cité, Paris, France
| | - Damien Llanas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Giao Vu-Bezin
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Carole Rubino
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Florent de Vathaire
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Véronique Letort
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Rodrigue Setcheou Allodji
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
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Journy NMY, Zrafi WS, Bolle S, Fresneau B, Alapetite C, Allodji RS, Berchery D, Haddy N, Kobayashi I, Labbé M, Pacquement H, Pluchart C, Schwartz B, Souchard V, Thomas-Teinturier C, Veres C, Vu-Bezin G, Diallo I, de Vathaire F. Risk Factors of Subsequent Central Nervous System Tumors after Childhood and Adolescent Cancers: Findings from the French Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2020; 30:133-141. [PMID: 33033142 DOI: 10.1158/1055-9965.epi-20-0735] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood or adolescent cancer survivors are at increased risks of subsequent primary neoplasms (SPN) of the central nervous system (CNS) after cranial irradiation. In a large multicentric cohort, we investigated clinical and therapeutic factors associated with the long-term risk of CNS SPN, and quantified the dose-response relationships. METHODS We selected all CNS SPN cases diagnosed up to 2016 among members of the French Childhood Cancer Survivor Study at least 5 years after first cancer diagnosis in 1946-2000. Four controls per case were randomly selected within the cohort and matched by sex, year of/age at first cancer diagnosis, and follow-up time. On the basis of medical and radiological reports, cumulative radiation doses received to the SPN or matched location were retrospectively estimated using mathematical phantoms. We computed conditional logistic regression models. RESULTS Meningioma risk significantly increased with higher radiation doses [excess OR per Gy (EOR/Gy) = 1.377; P < 0.001; 86 cases; median latency time = 30 years], after adjustment for reported genetic syndromes and first CNS tumor. It was higher among youngest individuals at first cancer diagnosis, but did not vary with follow-up time. On the opposite, radiation-related glioma risk (EOR/Gy = 0.049; P = 0.11; 47 cases; median latency time = 17 years) decreased over time (P for time effect = 0.05). There was a significant association between meningioma risk and cumulative doses of alkylating agents, but no association with growth hormone therapy. CONCLUSIONS The surveillance of patients with cranial irradiation should continue beyond 30 years after treatment. IMPACT The identified risk factors may inform long-term surveillance strategies.
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Affiliation(s)
- Neige Marie Yvanne Journy
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France. .,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Wael Salem Zrafi
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France.,Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Brice Fresneau
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France.,Department of Children and Adolescent Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Claire Alapetite
- Department of Radiation Oncology, Institut Curie, Paris, France.,Institut Curie, Proton Therapy Center, Orsay, Paris, France
| | - Rodrigue Setcheou Allodji
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Delphine Berchery
- Department of Medical Information, Institut Claudius Régaud, Toulouse, France
| | - Nadia Haddy
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Isao Kobayashi
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Martine Labbé
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Hélène Pacquement
- Department of Pediatric Medical Oncology, Institut Curie, Paris, France
| | - Claire Pluchart
- Department of Pediatric Hematology-Oncology, Institut Jean Godinot, Reims, France
| | - Boris Schwartz
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Vincent Souchard
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Cécile Thomas-Teinturier
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France.,Department of Paediatric Endocrinology, APHP, Paris-Sud Hospital, site Bicêtre, Le Kremlin Bicêtre, France
| | - Cristina Veres
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France.,Inserm UMR 1030, Gustave Roussy Cancer Campus, Villejuif, Paris, France
| | - Giao Vu-Bezin
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Ibrahima Diallo
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
| | - Florent de Vathaire
- Inserm U1018, CESP, Radiation Epidemiology Team, Gustave Roussy, Villejuif, Paris, France.,Paris-Saclay, Paris-Sud University, Villejuif, Paris, France
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