Page 419 - 2014 Printable Abstract Book
P. 419
and treatment-related risk factors. Results: Twenty-eight survivors experienced a first CVA at a median
age of 31.2 years. The median time from primary cancer diagnosis was 24.9 years. The 35-year cumulative
incidence in survivors treated with CRT-only was 13.1% (95%CI, 3.5-21.8%), in survivors treated with SDRT-
only 6.3% (95%CI, 0-12.3%), and in survivors who had both CRT and SDRT 22.6% (95%CI, 6.2-36.0%). The
EQD2 was available for 411/438 (93.8%) survivors treated with CRT and/or SDRT. Our analyses showed
that both treatment locations significantly increased the risk of CVA in a dose-dependent manner (HRCRT
-1
-1
1.02 Gy ; 95%CI, 1.01-1.03, and HRSDRT 1.04 Gy ; 95%CI, 1.02-1.05). Conclusion: Our study showed that
childhood cancer survivors treated with CRT and/or SDRT have a very high risk of CVAs, as compared with
survivors who had no radiotherapy to the head, neck and/or upper chest. Focused follow-up strategies
with special attention for preventive strategies to reduce the risk of CVAs is needed.
1
1
(PS7-70) Non-cancer mortality in two radiation worker cohorts. Jianqi Zhang ; Daniel O. Stram ; Sarah
2
5
4
3
S. Cohen ; David Pawel ; Howard Sesso ; and John Boice , Division of Biostatistics, Department of
Preventive Medicine, University of Southern California, Los Angeles, CA ; EpidStat Institute, Ann Arbor,
1
2
3
MI ; Radiation Protection Division, U.S. Environmental Protection Agency, Washington, DC ; Division of
4
Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA ; and
5
National Council on Radiation Protection and Measurements, Washington, DC
As part of the Million Radiation Worker and Veteran Study (MWS), non-cancer mortality was
evaluated in two recently completed cohorts: Rocketdyne (Atomics International) and Mound. The aim is
to provide quantitative assessment of heart and cerebral vascular disease, and non-malignant respiratory
disease, sites for which there is evidence for radiation effects from high-dose treatment studies and, for
heart disease and stroke, from studies of the acutely exposed Japanese atomic bomb survivors but where
the evidence for low-dose and or low dose-rate effects remains sparse. The two cohorts are characterized
by long and complete follow up, beginning in the 1940s, and comprehensive organ-specific dose
reconstructions. Nearly a half-million bioassays (primarily urine samples) were available to reconstruct
organ doses from intakes of radionuclides including, polonium-210, plutonium-239, uranium aluminide,
and tritium. Linkages with national dosimetry data bases enabled the determination of career doses.
Among the 51,947 radiation workers in both cohorts, there were 6,369 deaths with heart disease listed
as the underlying cause, 1,036 such deaths from cerebral vascular disease, and 1,235 such deaths from
non-malignant respiratory disease. Pooled analyses of the two cohorts combined were conducted
adjusting for age, sex, calendar year and surrogate measures of SES such as education and job category.
RBE values (weighting factors for alpha particle organ dose) of 1, 10 and 20 were assumed and linear trend
statistics computed. Despite the long follow-up, large numbers of cases, and careful case assessment of
these outcome variables and despite the comprehensive dosimetry estimates (organ specific dose
estimates ranged from 0 to over 1 Gy depending upon organ and radionuclide intake) there was little
consistent evidence for increasing trends of outcome over dose categories. Future pooled analyses, will
however further increase statistical power to assess low dose and low-dose rate effects by analyzing
contributing as well as underlying cause of death and by including additional cohorts such as Mallinckrodt,
Los Alamos and other worker studies soon to be completed using the same general methodological
approaches to dose reconstruction, disease surveillance and statistical modeling.
age of 31.2 years. The median time from primary cancer diagnosis was 24.9 years. The 35-year cumulative
incidence in survivors treated with CRT-only was 13.1% (95%CI, 3.5-21.8%), in survivors treated with SDRT-
only 6.3% (95%CI, 0-12.3%), and in survivors who had both CRT and SDRT 22.6% (95%CI, 6.2-36.0%). The
EQD2 was available for 411/438 (93.8%) survivors treated with CRT and/or SDRT. Our analyses showed
that both treatment locations significantly increased the risk of CVA in a dose-dependent manner (HRCRT
-1
-1
1.02 Gy ; 95%CI, 1.01-1.03, and HRSDRT 1.04 Gy ; 95%CI, 1.02-1.05). Conclusion: Our study showed that
childhood cancer survivors treated with CRT and/or SDRT have a very high risk of CVAs, as compared with
survivors who had no radiotherapy to the head, neck and/or upper chest. Focused follow-up strategies
with special attention for preventive strategies to reduce the risk of CVAs is needed.
1
1
(PS7-70) Non-cancer mortality in two radiation worker cohorts. Jianqi Zhang ; Daniel O. Stram ; Sarah
2
5
4
3
S. Cohen ; David Pawel ; Howard Sesso ; and John Boice , Division of Biostatistics, Department of
Preventive Medicine, University of Southern California, Los Angeles, CA ; EpidStat Institute, Ann Arbor,
1
2
3
MI ; Radiation Protection Division, U.S. Environmental Protection Agency, Washington, DC ; Division of
4
Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA ; and
5
National Council on Radiation Protection and Measurements, Washington, DC
As part of the Million Radiation Worker and Veteran Study (MWS), non-cancer mortality was
evaluated in two recently completed cohorts: Rocketdyne (Atomics International) and Mound. The aim is
to provide quantitative assessment of heart and cerebral vascular disease, and non-malignant respiratory
disease, sites for which there is evidence for radiation effects from high-dose treatment studies and, for
heart disease and stroke, from studies of the acutely exposed Japanese atomic bomb survivors but where
the evidence for low-dose and or low dose-rate effects remains sparse. The two cohorts are characterized
by long and complete follow up, beginning in the 1940s, and comprehensive organ-specific dose
reconstructions. Nearly a half-million bioassays (primarily urine samples) were available to reconstruct
organ doses from intakes of radionuclides including, polonium-210, plutonium-239, uranium aluminide,
and tritium. Linkages with national dosimetry data bases enabled the determination of career doses.
Among the 51,947 radiation workers in both cohorts, there were 6,369 deaths with heart disease listed
as the underlying cause, 1,036 such deaths from cerebral vascular disease, and 1,235 such deaths from
non-malignant respiratory disease. Pooled analyses of the two cohorts combined were conducted
adjusting for age, sex, calendar year and surrogate measures of SES such as education and job category.
RBE values (weighting factors for alpha particle organ dose) of 1, 10 and 20 were assumed and linear trend
statistics computed. Despite the long follow-up, large numbers of cases, and careful case assessment of
these outcome variables and despite the comprehensive dosimetry estimates (organ specific dose
estimates ranged from 0 to over 1 Gy depending upon organ and radionuclide intake) there was little
consistent evidence for increasing trends of outcome over dose categories. Future pooled analyses, will
however further increase statistical power to assess low dose and low-dose rate effects by analyzing
contributing as well as underlying cause of death and by including additional cohorts such as Mallinckrodt,
Los Alamos and other worker studies soon to be completed using the same general methodological
approaches to dose reconstruction, disease surveillance and statistical modeling.
