Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study.
Gregory T. Armstrong,Qi Liu,Yutaka Yasui,Sujuan Huang,Kirsten K. Ness,Wendy Leisenring,Melissa M. Hudson,Sarah S. Donaldson,Allison A. King,Marilyn Stovall,Kevin R. Krull,Leslie L. Robison,Roger J. Packer +12 more
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TLDR
Survivors of childhood CNS malignancies are at high risk for late mortality and for developing subsequent neoplasms and chronic medical conditions and care providers should be informed of these risks so they can provide risk-directed care and develop screening guidelines.Abstract:
Methods We collected information on treatment, mortality, chronic medical conditions, and neurocognitive functioning of adult 5-year survivors of CNS malignancies diagnosed between 1970 and 1986 within the Childhood Cancer Survivor Study. Using competing risk framework, we calculated cumulative mortality according to cause of death and cumulative incidence of subsequent neoplasms according to exposure and dose of cranial radiation therapy (RT). Neurocognitive impairment and socioeconomic outcomes were assessed with respect to dose of CNS radiotherapy to specific brain regions. Cumulative incidence of chronic medical conditions was compared between survivors and siblings using Cox regression models. All tests of statistical significance were two-sided. Results Among all eligible 5-year survivors (n = 2821), cumulative late mortality at 30 years was 25.8% (95% confidence interval [CI] = 23.4% to 28.3%), due primarily to recurrence and/or progression of primary disease. Patients who received cranial RT of 50 Gy or more (n = 813) had a cumulative incidence of a subsequent neoplasm within the CNS of 7.1% (95% CI = 4.5% to 9.6%) at 25 years from diagnosis compared with 1.0% (95% CI = 0% to 2.3%) for patients who had no RT. Survivors had higher risk than siblings of developing new endocrine, neurological, or sensory complications 5 or more years after diagnosis. Neurocognitive impairment was high and proportional to radiation dose for specific tumor types. There was a dosedependent association between RT to the frontal and/or temporal lobes and lower rates of employment, and marriage. Conclusions Survivors of childhood CNS malignancies are at high risk for late mortality and for developing subsequent neoplasms and chronic medical conditions. Care providers should be informed of these risks so they can provide risk-directed care and develop screening guidelines. J Natl Cancer Inst 2009;101: 946 – 958read more
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ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs – Threshold Doses for Tissue Reactions in a Radiation Protection Context
F A Stewart,A V Akleyev,Martin Hauer-Jensen,Jolyon H Hendry,N J Kleiman,Thomas J. MacVittie,B M Aleman,Angela B. Edgar,K Mabuchi,C R Muirhead,Roy E. Shore,William Wallace +11 more
TL;DR: Estimates of ‘practical’ threshold doses for tissue injury defined at the level of 1% incidence are provided and it appears that the rate of dose delivery does not modify the low incidence for reactions manifesting very late after low total doses, particularly for cataracts and circulatory disease.
ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs -- threshold doses for tissue reactions in a radiation protection context
C. H. Clement,F. A. Stewart +1 more
TL;DR: In this paper, the authors present a statement on the early and late effects of ionising radiation in normal tumor and kidney responses to irradiation, as well as some modifications of normal tumor response.
Journal ArticleDOI
Vismodegib Exerts Targeted Efficacy Against Recurrent Sonic Hedgehog–Subgroup Medulloblastoma: Results From Phase II Pediatric Brain Tumor Consortium Studies PBTC-025B and PBTC-032
Giles W. Robinson,Brent A. Orr,Gang Wu,Sridharan Gururangan,Tong Lin,Ibrahim Qaddoumi,Roger J. Packer,Stewart Goldman,Michael D. Prados,Annick Desjardins,Murali Chintagumpala,Naoko Takebe,Sue C. Kaste,Michael Rusch,Sariah Allen,Arzu Onar-Thomas,Clinton F. Stewart,Maryam Fouladi,James M. Boyett,Richard J. Gilbertson,Tom Curran,David W. Ellison,Amar Gajjar +22 more
TL;DR: Molecular analyses support the hypothesis that SMO inhibitor activity depends on the genomic aberrations within the tumor and should be advanced in SHH-MB studies.
Journal ArticleDOI
Testicular Cancer Survivorship: Research Strategies and Recommendations
Lois B. Travis,Clair J. Beard,James M. Allan,Alv A. Dahl,Darren R. Feldman,Jan Oldenburg,Gedske Daugaard,Jennifer L. Kelly,M. Eileen Dolan,Robyn Hannigan,Louis S. Constine,Kevin C. Oeffinger,Paul Okunieff,Greg Armstrong,David Wiljer,Robert C. Miller,Jourik A. Gietema,Flora E. van Leeuwen,Jacqueline P. Williams,Craig R. Nichols,Lawrence H. Einhorn,Sophie D. Fosså +21 more
TL;DR: Just as testicular cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of testicularcancer survivors can pioneer new methodologies in survivorship research for all adult-onset cancer.
Journal ArticleDOI
Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study
Torunn I. Yock,Beow Y. Yeap,David H. Ebb,Elizabeth A. Weyman,Bree R. Eaton,Bree R. Eaton,Nicole A. Sherry,Robin M. Jones,Shannon M. MacDonald,Margaret B. Pulsifer,Beverly Lavally,Annah N. Abrams,Mary S. Huang,Karen J. Marcus,Nancy J. Tarbell +14 more
TL;DR: Proton radiotherapy resulted in acceptable toxicity and had similar survival outcomes to those noted with conventional radiotherapy, suggesting that the use of the treatment may be an alternative to photon-based treatments.
References
More filters
Book
An introduction to the bootstrap
Bradley Efron,Robert Tibshirani +1 more
TL;DR: This article presents bootstrap methods for estimation, using simple arguments, with Minitab macros for implementing these methods, as well as some examples of how these methods could be used for estimation purposes.
Journal ArticleDOI
Longitudinal data analysis using generalized linear models
Kung Yee Liang,Scott L. Zeger +1 more
TL;DR: In this article, an extension of generalized linear models to the analysis of longitudinal data is proposed, which gives consistent estimates of the regression parameters and of their variance under mild assumptions about the time dependence.
Journal ArticleDOI
A Class of $K$-Sample Tests for Comparing the Cumulative Incidence of a Competing Risk
TL;DR: In this paper, a class of tests developed for comparing the cumulative incidence of a particular type of failure among different groups is presented. The tests are based on comparing weighted averages of the hazards of the subdistribution for the failure type of interest.
Book
International Classification of Diseases for Oncology
TL;DR: This list of diseases for oncology includes cancers of the central nervous system, as well as other types of diseases such as lymphoma, leukaemia, and so on.
Journal ArticleDOI
Chronic Health Conditions in Adult Survivors of Childhood Cancer
Kevin C. Oeffinger,Ann C. Mertens,Charles A. Sklar,Toana Kawashima,Melissa M. Hudson,Anna T. Meadows,Debra L. Friedman,Neyssa Marina,Wendy L. Hobbie,Nina S. Kadan-Lottick,Cindy L. Schwartz,Wendy M. Leisenring,Leslie L. Robison +12 more
TL;DR: Survivors of childhood cancer have a high rate of illness owing to chronic health conditions, including severe, disabling, or life-threatening conditions or death due to a chronic condition.