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

TY - JOUR

T1 - Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale

AU - Brodin, N. Patrik

AU - Vogelius, Ivan R.

AU - Maraldo, Maja V.

AU - Munck af Rosenschöld, Per Martin

AU - Aznar, Marianne C.

AU - Berthelsen, Anne Kiil

AU - Nilsson, Per

AU - Bjork-Eriksson, Thomas

AU - Specht, Lena

AU - Bentzen, Soren M.

PY - 2012/11/1

Y1 - 2012/11/1

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

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

KW - life years lost

KW - radiotherapy

KW - late effects

KW - secondary cancers

KW - risk modeling

U2 - 10.1002/cncr.27536

DO - 10.1002/cncr.27536

M3 - Journal article

C2 - 22517408

SN - 0008-543X

VL - 118

SP - 5432

EP - 5440

JO - Cancer

JF - Cancer

IS - 21

ER -