Modeling long-term mortality and morbidity in pediatric Hodgkin lymphoma survivors after reduced radiotherapy exposure
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ID: 317246
2026
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Abstract
BACKGROUND: Long-term survivors of pediatric Hodgkin lymphoma are at risk of late treatment-related mortality, cancer, and heart disease. While modified treatments have reduced radiation exposure, long-term risks in late adulthood are unknown. METHODS: Using a simulation model based on data from the Childhood Cancer Survivor Study and national databases, we projected overall survival and cumulative incidence of breast cancer and heart failure for 5-year survivors treated with extended-field RT, chest RT ≥ 35 Gy, chest RT < 35 Gy, or chemotherapy only. Estimates were compared with general population individuals who faced only age-related risks. We report the mean and 95% uncertainty intervals (UIs) among 1000 iterations. RESULTS: At age 65, projected overall survival ranged from 24.7% (95% UI, 17.7 to 32.5) after extended-field RT to 71.8% (44.9 to 81.8) after chemotherapy only, compared with 86.4% (83.8 to 88.8) in the general population. Cumulative breast cancer incidence among female survivors was 61.1% for extended-field RT, 59.7% for chest RT ≥ 35 Gy, 49.8% for chest RT < 35 Gy, and 17.9% for chemotherapy only, respectively, versus 6.1% in the general population. Heart failure risks among all survivors were 34.8%, 33.4%, 28.4%, and 16.0, respectively, versus 4.3%. Across all subgroups, breast cancer and heart failure were projected to occur 16.1-31.7 and 21.0-25.9 years earlier, respectively, relative to general population risks at age 65. CONCLUSIONS: Although historical reductions in RT dose and field have substantially improved long-term survival, survivors treated with lower-dose or chemotherapy alone remain at markedly elevated risk for early-onset breast cancer and heart failure.
| Reference Key |
openalex_W7164647889
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| Authors | Jenna R. Rogers, Zachary J. Ward, Kayla Stratton, Wendy M. Leisenring, Chelsea S Taylor, Gregory T Armstrong, Eric J Chow, Angela M. Feraco, Rebecca M Howell, Melissa M Hudson, Mercedes McMahon, Lindsay M Morton, Kevin C Oeffinger, Susan A Smith, LR Diller, Jennifer M. Yeh |
| Journal | JNCI Journal of the National Cancer Institute |
| Year | 2026 |
| DOI |
10.1093/jnci/djag186
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| URL | |
| Keywords | Keywords not found |
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