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Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study.

Publication ,  Journal Article
Friedman, DN; Moskowitz, CS; Hilden, P; Howell, RM; Weathers, RE; Smith, SA; Wolden, SL; Tonorezos, ES; Mostoufi-Moab, S; Chow, EJ; Meacham, LR ...
Published in: J Natl Cancer Inst
May 1, 2020

BACKGROUND: Childhood cancer survivors exposed to abdominal radiation (abdRT) are at increased risk for diabetes mellitus, but the association between risk and radiation dose and volume is unclear. METHODS: Participants included 20 762 5-year survivors of childhood cancer (4568 exposed to abdRT) and 4853 siblings. For abdRT, we estimated maximum dose to abdomen; mean doses for whole pancreas, pancreatic head, body, tail; and percent pancreas volume receiving no less than 10, 20, and 30 Gy. Relative risks (RRs) were estimated with a Poisson model using generalized estimating equations, adjusted for attained age. All statistical tests were two-sided. RESULTS: Survivors exposed to abdRT (median age = 31.6 years, range = 10.2-58.3 years) were 2.92-fold more likely than siblings (95% confidence interval [CI] = 2.02 to 4.23) and 1.60-times more likely than survivors not exposed to abdRT (95%CI = 1.24 to 2.05) to develop diabetes. Among survivors treated with abdRT, greater attained age (RRper 10 years = 2.11, 95% CI = 1.70 to 2.62), higher body mass index (RRBMI 30+ = 5.00, 95% CI = 3.19 to 7.83 with referenceBMI 18.5-24.9), and increasing pancreatic tail dose were associated with increased diabetes risk in a multivariable model; an interaction was identified between younger age at cancer diagnosis and pancreatic tail dose with much higher diabetes risk associated with increasing pancreatic tail dose among those diagnosed at the youngest ages (P < .001). Radiation dose and volume to other regions of the pancreas were not statistically significantly associated with risk. CONCLUSIONS: Among survivors treated with abdRT, diabetes risk was associated with higher pancreatic tail dose, especially at younger ages. Targeted interventions are needed to improve cardiometabolic health among those at highest risk.

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Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

May 1, 2020

Volume

112

Issue

5

Start / End Page

525 / 532

Location

United States

Related Subject Headings

  • Young Adult
  • Radiotherapy Dosage
  • Radiation Injuries
  • Pancreas
  • Oncology & Carcinogenesis
  • North America
  • Neoplasms
  • Middle Aged
  • Male
  • Humans
 

Citation

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Friedman, D. N., Moskowitz, C. S., Hilden, P., Howell, R. M., Weathers, R. E., Smith, S. A., … Sklar, C. A. (2020). Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst, 112(5), 525–532. https://doi.org/10.1093/jnci/djz152
Friedman, Danielle Novetsky, Chaya S. Moskowitz, Patrick Hilden, Rebecca M. Howell, Rita E. Weathers, Susan A. Smith, Suzanne L. Wolden, et al. “Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study.J Natl Cancer Inst 112, no. 5 (May 1, 2020): 525–32. https://doi.org/10.1093/jnci/djz152.
Friedman DN, Moskowitz CS, Hilden P, Howell RM, Weathers RE, Smith SA, et al. Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2020 May 1;112(5):525–32.
Friedman, Danielle Novetsky, et al. “Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study.J Natl Cancer Inst, vol. 112, no. 5, May 2020, pp. 525–32. Pubmed, doi:10.1093/jnci/djz152.
Friedman DN, Moskowitz CS, Hilden P, Howell RM, Weathers RE, Smith SA, Wolden SL, Tonorezos ES, Mostoufi-Moab S, Chow EJ, Meacham LR, Chou JF, Whitton JA, Leisenring WM, Robison LL, Armstrong GT, Oeffinger KC, Sklar CA. Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2020 May 1;112(5):525–532.
Journal cover image

Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

May 1, 2020

Volume

112

Issue

5

Start / End Page

525 / 532

Location

United States

Related Subject Headings

  • Young Adult
  • Radiotherapy Dosage
  • Radiation Injuries
  • Pancreas
  • Oncology & Carcinogenesis
  • North America
  • Neoplasms
  • Middle Aged
  • Male
  • Humans