Radiotherapy for certain childhood cancers linked to long-term cardiometabolic effects
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Adults who received radiation therapy during childhood for abdominal and pelvic cancers appeared more likely than the general population to experience body composition abnormalities and worse cardiometabolic outcomes, study results showed.
“This research was prompted by our observational evidence from the Childhood Cancer Survivor Study that showed patients treated for abdominal and pelvic tumors with radiation had higher rates of diabetes than expected,” Carmen L. Wilson, PhD, researcher in the department of epidemiology and cancer control at St. Jude Children’s Research Hospital, told Healio. “We wondered if this was not only because the pancreas may have been exposed to damage from radiation, but also because they had abnormal body composition — less lean tissue than expected — even if a normal weight.”
The study, published in Cancer Epidemiology, Biomarkers & Prevention, included 431 adult survivors of childhood cancer (median age, 29.9 years; range, 18.7-55.1; 79.1% white) who underwent treatment for abdominal or pelvic solid tumors at St. Jude Children’s Research Hospital. Common cancer types among participants included neuroblastoma (16.5%), Wilms tumor (42.9%) and germ cell tumor (14.8%). Median age at diagnosis was 3.6 years (range, 0-24.8 years), and 36.9% of participants underwent abdominal radiation therapy, whereas 35.7% received pelvic radiation therapy.
Wilson and colleagues assessed the long-term effect of radiation therapy by comparing body composition, metabolic abnormalities and physical function with age-, sex- and ethnicity-matched data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES).
Compared with the NHANES data, childhood cancer survivors had a higher prevalence of insulin resistance (40.6% vs. 33.8%, P = .006), high triglycerides (18.4% vs. 10%, P < .001) and low HDL (33.5% vs. 28.9%, P = .046).
Researchers additionally found that survivors were more likely to have lower relative lean body mass among men (Z-score = 0.67 ± 1.27; P < .001) and women (Z-score = 0.72 ± 1.28; P < .001), and lower lean body mass was associated with prior radiation dose among men (abdominal: beta = 0.22, standard error [SE] ± 0.07; P = .002; pelvic: beta = 0.23, SE ± 0.07; P = .002) and women (abdominal: beta = 0.3, SE ± 0.09; P = .001; pelvic: beta = 0.16, SE ± 0.08; P = .037).
Although researchers observed no significant differences in relative body fat composition, survivors who had high relative fat composition had reduced quadricep strength and poor physical performance compared with survivors who had low relative body fat composition. Survivors with high to normal muscle and high adiposity had an increased risk for low HDL (RR = 1.82; 95% CI, 1.32-2.51).
Compared with female survivors, male survivors had a higher risk for high LDL (RR = 2.54; 95% CI, 1.64-3.93) and high triglyceride levels (RR = 2.1; 95% CI, 1.35-3.27). Smokers had increased risk for low HDL levels (RR = 1.66; 95% CI, 1.21-2.28) and high triglyceride levels (RR = 1.67; 95% CI, 1.07-2.62).
The fact that cardiometabolic outcomes may have been measured differently among survivors and NHANES participants served as a study limitation.
“Interventions focused on increasing lean mass — for example, resistance training accompanied by adequate dietary protein intake — may impact physiological markers, such as lipids and insulin, associated with heart disease,” Wilson told Healio. “Future research should both evaluate muscle health in young cancer survivors and test interventions designed to improve lean muscle mass.”
For more information:
Carmen L. Wilson, PhD, can be reached at St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105; email: carmen.wilson@stjude.org.
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