Acute toxicity grade 3 and 4 after irradiation in children and adolescents: results from the IPPARCA collaboration
Menée à partir de données portant sur 1 359 patients pédiatriques atteints d'un cancer traité par radiothérapie (âge : 0 à 18 ans), cette étude évalue la proportion de patients présentant des événements indésirables de grade III ou IV, puis identifie les facteurs associés
Background and Purpose : In 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 Methods : Irradiated 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. Results : As 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. Conclusion : In 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.