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Background and purpose A cohort study was performed to investigate the carcinogenic effect of treatment with ionizing radiation of skin hemangioma in early childhood. This study presents the incidence of differentiated thyroid and breast cancers after radiotherapy in this cohort. Methods and Materials: Of a total of 8307 patients treated for a skin hemangioma between 1940 and 1973 at the Institut Gustave-Roussy, 4 767 (3 317 women) were included in an incidence study, among whom 3 795 (2 698 women) received radiotherapy. External radiotherapy, Radium 226, Strontium 90, Yttrium 90, and Phosphorus 32 were used as treatment. The mean age at first exposure was 0.7 years and the mean absorbed dose to the breast was 70 mGy and 41 mGy to the thyroid. Breast and Thyroid tumors cases were obtained by sending a questionnaire, and verified from pathological reports. Estimation of breast and thyroid cancer specific incidence rates in French population was obtained from French cancer registry network. External and internal analyses were performed. Results: During an average follow-up of 35 years, a total of 11 patients developed a differentiated thyroid carcinoma and 19 women developed BC, i.e. respectively 2.5 (95%CI: 1.4-4.4) and 2.5 (95% CI 1.5-3.8) more than expected from French general population. An association between weight and BMI at age 18 and BC risk was observed. Thyroid carcinoma incidence was higher in non-smoker patients. As compared with patients who had not received radiotherapy, those who had, had a 3.5 times higher (9%CI : 2.2-5.4 ) risk of developing a BC. Despite the risk of BC was multiplied by 3.6, 6.0, 7.9, for dose of radiation to breast varying, respectively from, 0 to 10, from 10 to 100, and > 100 (mGy), as compared to patients who did not received radiotherapy, the dose response was not significant. However, a significant dose response relationship was estimated between the radiation dose received to thyroid and the risk of thyroid cancer (Excess Relative Risk per GY, ERR/Gy: 14.7, 95%CI: 1.6 - 62.9). Conclusion: This study confirms that radiation treatment performed in the past for hemangioma during infancy increased the risk of thyroid and breast cancers.

Background Childhood cancer survival has increased considerably during the last 3 decades. Until now, little has been known about the risk factors for death due to cardiovascular diseases in long-term survivors of a childhood cancer. Methods We investigated long-term mortality in a cohort of 4 122 5-year survivors (aged 0-15 years) of a childhood cancer treated between 1942 and 1986 in 8 centres in France and Great Britain as having a solid cancer and followed up over an average of 26 years. 98% of vital status were obtained from INSEE and 95% of causes of death from Cepi-Dc. Information about chemotherapy was collected, and the radiation dose received in all except for 159 of the 2 870 patients, who had received radiotherapy was estimated, The radiation dose received at 188 anatomical sites are estimated for each radiotherapy course of every child. The classification of causes of death was based on a comparison between the code topographic first cancer and the leading cause of death. The causes of death from heart disease the most common are: heart disease, heart failure and acute myocardial infarction Results A total of 603 patients died during the follow-up, i.e. 8.3-fold (95% CI 7.6-9.0) more than that expected in the general population. A total of 32 patients died of cardiovascular diseases, i.e. 4.8-fold (95% CI 3.3-6.7) more than expected, 21 of which were cardiac diseases, i.e. 6.0-fold (95% CI 3.8-9.0) more than expected. Patients who had received radiotherapy had a 5.4-fold (95% CI 1.6-33.0) higher risk of mortality due to cardiovascular disease than those who had not. Mortality due to cardiac disease was related to the administration of anthracyclines, alkylating agents and/or vinca alkaloids. Patients who had received between 5 to 14.9 Gy to the heart during radiotherapy had a 14.5-fold (95% CI 2-291) higher risk of mortality from cardiac diseases than patients who had not received radiotherapy. Patients who had received on average, more than 5 Gy to the brain were at a higher risk of developing vascular diseases (n=11). Conclusions Childhood cancer survivors are at a high long-term risk of mortality from cardiac diseases when treated with radiotherapy if the average radiation dose to the heart is higher than 5 Gy, or with anthracyclines, alkylating agents and/or vinca alkaloids. The cardiovascular diseases are the causes non-cancerous most frequent in the very long term after treatment for cancer of the child.

Public Health Codes more and more require that any information relevant to the estimation of the high doses delivered within the target volumes and low doses delivered outside should be recorded. In this context, the availability for each radiotherapy patient of the magnitude of the unavoidable low doses delivered outside the target-volumes becomes an important issue. However, to date, Treatment Planning Systems (TPS) are not designed for this issue. Therefore, we have developed a new version of the ISOgray TPS which can provide, in addition to the doses distributions in the fields, the magnitude of the doses to distant healthy tissues in the course of common radiotherapeutic procedures. Our strategy involves 3 modules: A library of adjustable whole-body patient models in treatment position which allows different patient anatomies to be simulated; A multi-sources beam model, which allows the description of the irradiation field to be extended to the whole body; A dose calculation engine producing the distributions of doses in the fields and in any organ outside. This paper describes the principles of the system and provides data on doses distributions to distant organs for various common radiotherapeutic procedures. At this stage of development, the agreement of measured and calculated doses reaches ±3% in the radiation field and is better than ±15% outside. In the case of a 17 years aged girl treated for Hodgkin's disease using two 6MV opposite photon beams, when a dose of 20 Gy was delivered to the target volume, outside the beam, the dose to the brain was 0.37 Gy (1.85% of the tumor dose), the kidney 0.06 Gy (0.30%) and the ovaries below 0.02 Gy (

Nous rapportons ici une serie de 153 grossesses irradiees de facon accidentelle en debut de gestation, toutes analysees selon le meme mode dosimetrique. Aucune indication d’interruption therapeutique de grossesse n’a ete posee, aucune de nos consultantes n’ayant recu plus de 100 mGy. Les taux de malformation et d'avortement spontane sont identiques a ceux observes dans le reste de la population.