Radiation dose and volume to the pancreas and subsequent risk of diabetes mellitus: A report from the Childhood Cancer Survivor Study Journal Article


Authors: Novetsky Friedman, D.; Moskowitz, C. S.; Hilden, P.; Howell, R. M.; Weathers, R. E.; Smith, S. A.; Wolden, S. L.; Tonorezos, E. S.; Mostoufi-Moab, S.; Chow, E. J.; Meacham, L. R.; Chou, J. F.; Whitton, J. A.; Leisenring, W. M.; Robison, L. L.; Armstrong, G. T.; Oeffinger, K. C.; Sklar, C. A.
Article Title: Radiation dose and volume to the pancreas and subsequent risk of diabetes mellitus: A report from the Childhood Cancer Survivor Study
Abstract: 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. © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Journal Title: JNCI: Journal of the National Cancer Institute
Volume: 112
Issue: 5
ISSN: 0027-8874
Publisher: Oxford University Press  
Date Published: 2020-05-01
Start Page: 525
End Page: 532
Language: English
DOI: 10.1093/jnci/djz152
PUBMED: 31329225
PROVIDER: scopus
PMCID: PMC7225668
DOI/URL:
Notes: Article -- Export Date: 1 June 2020 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    197 Chou
  2. Charles A Sklar
    298 Sklar
  3. Suzanne L Wolden
    453 Wolden
  4. Chaya S. Moskowitz
    196 Moskowitz
  5. Patrick Dale Hilden
    94 Hilden