[en] Concern has been raised about the potential risks related to radiation exposure from CT scans, particularly among children. However, to date, there are few data available describing the magnitude of pediatric CT utilization. The aim of the study was to explore patterns of CT use in pediatric patients, with respect to time, use of multiple scans, body regions imaged, and medical diagnoses. Records of 22,223 scans performed on 18,075 people aged ≤18 years over the period 1999-2003, including diagnoses recorded within 21 days after the examination, were obtained from a large Israeli Health Maintenance Organization (1,600,000 members). The highest annual CT examination rate (per 1,000) was recorded in 2001 (10.1) compared to 7.0 and 6.3 in 1999 and 2003, respectively. The lowest rate (three scans per 1,000) was found for 3-year-old children, with increasing rates with age. The head was the most frequently scanned region, both in young children (78%) and adolescents (39%). Symptoms of ill-defined conditions and injuries were documented in 22% and 10% of all scans, respectively. Although the results suggest that children comprise only 3% of all patients undergoing CT, this important modality must be carefully used because of their increased radiosensitivity, higher effective radiation doses, and longer life expectancy. (orig.)

[en] Breast hypoplasia and impaired lactation are poorly studied sequelae of chest radiation therapy (RT) in children. The Pediatric Normal Tissue Effects in the Clinic female breast task force aimed to quantitate the radiation dose-volume effects on these endpoints.

[en] Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children.

[en] To evaluate trends and patterns in CT usage among children (aged 0-17 years) in The Netherlands during the period 1990-2012. Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds). Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older. The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades. (orig.)

[en] 

Purpose

Childhood cancer survivors are at increased risk of developing subsequent malignant neoplasms (SMNs). We compared survival and clinical characteristics of survivors with SMNs (sarcoma, breast cancer, or melanoma) and a population-based sample of similar first malignant neoplasm (FMN) patients.

Methods

We assembled three case series of solid SMNs observed in a cohort of 5-year Dutch childhood cancer survivors diagnosed 1963–2001 and followed until 2014: sarcoma (n = 45), female breast cancer (n = 41), and melanoma (n = 17). Each SMN patient was sex-, age-, and calendar year-matched to 10 FMN patients in the population-based Netherlands Cancer Registry. We compared clinical and histopathological characteristics by Fisher’s exact tests and survival by multivariable Cox regression and competing risk regression analyses.

Results

Among sarcoma-SMN patients, overall survival [hazard ratio (HR) 1.88, 95% confidence interval (CI) 1.23–2.87] and sarcoma-specific mortality (HR 1.91, 95% CI 1.16–3.13) were significantly worse compared to sarcoma-FMN patients (foremost for soft-tissue sarcoma), with 15-year survival rates of 30.8% and 61.6%, respectively. Overall survival did not significantly differ for breast-SMN versus breast-FMN patients (HR 1.14, 95% CI 0.54–2.37), nor for melanoma-SMN versus melanoma-FMN patients (HR 0.71, 95% CI 0.10–5.00). No significant differences in tumor characteristics were observed between breast-SMN and breast-FMN patients. Breast-SMN patients were treated more often with mastectomy without radiotherapy/chemotherapy compared to breast-FMN patients (17.1% vs. 5.6%).

Conclusions

Survival of sarcoma-SMN patients is worse than sarcoma-FMN patients. Although survival and tumor characteristics appear similar for breast-SMN and breast-FMN patients, treatment differs; breast-SMN patients less often receive breast-conserving therapy. Larger studies are necessary to substantiate these exploratory findings.

[en] The use of ionising radiation (IR) for medical diagnosis and treatment procedures has had a major impact on the survival of paediatric patients. Although the benefits of these techniques largely outweigh the risks, the evidence to date suggests that children are more sensitive than adults to the carcinogenic effects of IR. Therefore, there is a need to better understand the long-term health effects of such exposures in order to optimise treatment in these young patients and reduce the risk of late toxicities. HARMONIC aims to improve our understanding of the health effects of exposure to medical IR in children, specifically cancer patients treated with modern radiotherapy techniques, and cardiac patients treated with cardiac fluoroscopy procedures (CFP). HARMONIC also develops dosimetric data collection software tools to allow dose reconstruction in both CFP and radiotherapy. The project builds on a multi-disciplinary collaboration to investigate long-term outcomes (endocrine dysfunction, cardiovascular and neurovascular damage, quality of life (QoL) and social impacts, and secondary cancers) of paediatric cancer patients after the application of modern radiotherapy modalities. Instruments for harmonised demographic, clinical and dosimetric data collection were defined serving as a pilot phase for a future pan-European registry. The cardiac component of HARMONIC builds a pooled cohort of approximately 100,000 patients who underwent CFP in 7 countries, while aged under 22 years. The cohort, based on data collection from hospital records and/or insurance claims data, will be followed-up using national registries and insurance records to determine vital status and cancer incidence. Where available, information on organ transplantation (a major risk factor for cancer development in this patient group) and/or other conditions predisposing to cancer will be obtained from national or local registries and health insurance data. The relationship between estimated radiation dose and cancer risk will be investigated using regression modelling. With its prospective design and the creation of a biobank for the collection of biological samples, HARMONIC also aims at providing a mechanistic understanding of radiation-induced adverse health effects and identify potential biomarkers indicative of vascular adverse effects and secondary cancer. These biomarkers could ultimately contribute to early diagnosis, treatment and prevention of adverse effects. (authors)