Acute toxicity grade 3 and 4 after irradiation in children and adolescents: results from the IPPARCA collaboration

Publication date: Available online 19 December 2015
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Caroline Pixberg, Raphael Koch, Hans-Theodor Eich, Ulla Martinsson, Ingrid Kristensen, Christiane Matuschek, Rolf-Dieter Kortmann, Fabian Pohl, Khaled Elsayad, Hans Christiansen, Normann Willich, Jack Lindh, Diana Steinmann
Background and PurposeIn the context of oncologic therapy for children, radiotherapy is frequently indicated. The aim of this study was to identify the frequency of and reasons for the development of high-grade acute toxicity and possible sequelae.Patients and MethodsIrradiated children have been prospectively documented since 2001 in the RiSK-registry in Germany and since 2008 in the RADTOX-registry in Sweden. Data were collected using standardized, previously published forms. Toxicity classification was based on the criteria of RTOG/EORTC.ResultsAs of June 2013, 1500 children had been recruited into the RiSK-database and 485 into the RADTOX-registry leading to an analysis population of 1359 patients (age range 0-18). A total of 18.9% (n=257) of all investigated patients developed high-grade acute toxicity (grade 3/4). High-grade toxicity of the bone marrow was documented for 63.8% (n=201) of those patients, oral mucositis for 7.6% (n=24) and dermatitis for 7.6% (n=24). Patients with high-grade acute toxicity received concomitant chemotherapy more frequently (56%) compared to patients with no or lower acute toxicity (31.5%). In multivariate analyses, concomitant chemotherapy, a diagnosis of Ewing sarcoma and total radiation dose showed a statistically noticeable effect (p≤0.05) on acute toxicity, whereas age, concomitant chemotherapy, Hodgkin lymphoma, Ewing sarcoma, total radiation dose, acute toxicity influenced the time until maximal late toxicity.ConclusionIn general high-grade acute toxicity after irradiation in children and adolescence occurs in a moderate proportion of patients (18.9%). As anticipated, the probability of acute toxicity appeared to depend on the prescribed dose as well as concomitant chemotherapy. The occurrence of chronic toxicity correlates with the prior acute toxicity grade. Age seems to influence the time until maximal late toxicity but not the development of acute toxicity.

Teaser

In the context of radiotherapy at children the aim of this study is to identify the frequency and reasons of the development of a high grade acute toxicity as well as possible sequelae. For this purpose prospectively documented data of irradiated children is evaluated whereby for the first time data of two international projects is combined ("Risk" and "IPPARCA"). From this we gain better inside into the side effects of radiotherapy.


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