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09.12.2020 | Original Article

The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma

verfasst von: Anni Young Lundgaard, MD, Lisa Lyngsie Hjalgrim, MD, PhD, Laura Ann Rechner, MSc, PhD, Michael Lundemann, MSc, PhD, N. Patrik Brodin, MSc, PhD, Morten Joergensen, MD, Lena Specht, MD, DMSc, Maja Vestmoe Maraldo, MD, PhD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 8/2021

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Abstract

Purpose

Adolescent young adults (AYA) with Hodgkin lymphoma (HL) are treated according to either pediatric or adult protocols, however, the best strategy has yet to be established. We describe the AYA patients referred for radiotherapy and quantify the risk of radiation-induced late effects and the corresponding life years lost (LYL) following pediatric and adult regimens.

Methods

Patients ≤24 years irradiated for HL were included. For each patient, organs at risk (OARs) were contoured and dosimetric parameters were extracted. Estimated excess hazard ratios of radiation-induced late effects were calculated from dose-response models and LYL attributable to various late effects were estimated.

Results

In total, 77 patients were analyzed (pediatric regimen: 15; adult regimen: 62). Age, clinical stage, and the number of patients enrolled in protocols were significantly different between the groups. Pediatric patients had more advanced disease, which resulted in larger target volumes and higher doses to most OARs, despite a lower prescribed dose compared to adult regimens. LYL estimates were all higher with the pediatric regimens. Total LYL with pediatric and adult treatment regimens were 3.2 years and 2.3 years, respectively. Due to the clinical stage variation and heterogeneity in disease location, a direct comparison of the estimated risks of late effects was only exploratory.

Conclusion

Pediatric regimens selected patients with more advanced disease to radiotherapy resulting in larger target volumes and higher doses to the OARs. Target volume rather than prescribed dose impacted OAR exposure. Consequently, the estimated risk of radiation-induced late effects and corresponding LYL was increased when compared to adult regimens.

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Titel: The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma
verfasst von: Anni Young Lundgaard, MD
Lisa Lyngsie Hjalgrim, MD, PhD
Laura Ann Rechner, MSc, PhD
Michael Lundemann, MSc, PhD
N. Patrik Brodin, MSc, PhD
Morten Joergensen, MD
Lena Specht, MD, DMSc
Maja Vestmoe Maraldo, MD, PhD
Publikationsdatum: 09.12.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 8/2021
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01721-w

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The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma