Table 1.
Patient, Cancer, and Treatment Characteristics of the 5‐Year Survivors of the DCOG‐LATER Cohort With Complete Cardiac Follow‐Up
| Characteristics | Cohort With Cardiac Follow‐Up (n=5845) (94.8%)* | CCS With Heart Failure (n=116) |
|---|---|---|
| n (%) | n (%) | |
| Patient characteristics | ||
| Sex | ||
| Female | 2588 (44.3) | 44 (37.9) |
| Male | 3257 (55.7) | 72 (62.1) |
| Cancer characteristics | ||
| Primary childhood cancer (ICCC) | ||
| Leukemias, myeloproliferative diseases, and myelodysplastic diseases | 2034 (34.8) | 30 (25.9) |
| Lymphomas and reticuloendothelial neoplasms | 1019 (17.4) | 26 (22.4) |
| CNS and miscellaneous intracranial and intraspinal neoplasms | 749 (12.8) | 3 (2.6) |
| Neuroblastoma and other peripheral nervous cell tumors | 306 (5.2) | 2 (1.7) |
| Retinoblastoma | 29 (0.5) | 0 (0) |
| Renal tumors | 571 (9.8) | 11 (9.5) |
| Hepatic tumors | 46 (0.8) | 0 (0) |
| Bone tumors | 355 (6.1) | 25 (21.6) |
| Soft tissue and other extraosseous sarcomas | 422 (7.2) | 18 (15.5) |
| Germ cell tumors, trophoblastic tumors, and neoplasms of gonads | 219 (3.7) | 0 (0) |
| Other malignant epithelial neoplasms and malignant melanomas | 88 (1.5) | 1 (0.9) |
| Other and unspecified malignant neoplasms | 7 (0.1) | 0 (0) |
| Age at diagnosis (y), median (IQR) | 5.5 (2.8–10.5) | 6.1 (2.8–10.5) |
| 0 to 4 | 2692 (46.1) | 49 (42.2) |
| 5 to 9 | 1567 (26.8) | 35 (30.2) |
| 10 to 14 | 1233 (21.1) | 28 (24.1) |
| 15 to 17 | 353 (6.0) | 4 (3.4) |
| Treatment period | ||
| 1963 to 1979 | 990 (16.9) | 22 (19.0) |
| 1980 to 1989 | 1853 (31.7) | 58 (50.0) |
| 1990 to 2001 | 3002 (51.4) | 36 (31.0) |
| Overall treatment modality | ||
| Surgery only | 587 (10.0) | 0 (0) |
| Chemotherapy±Surgery | 2882 (49.3) | 60 (51.7) |
| Radiotherapy±Surgery | 445 (7.6) | 0 (0) |
| Chemotherapy and Radiotherapy±Surgery | 1854 (31.7) | 55 (47.4) |
| No therapy/unknown | 77 (1.3) | 1 (0.9) |
| Cardiotoxic treatment | ||
| No cardiotoxic treatment | 2845 (48.7) | 3 (2.6) |
| Cardiotoxic CT only | 2304 (39.4) | 83 (71.6) |
| RT involving the heart only | 211 (3.6) | 4 (3.4) |
| Cardiotoxic CT and chest RT | 434 (7.4) | 25 (21.6) |
| Unknown | 51 (0.9) | 1 (0.9) |
| Anthracyclines median dose (IQR) | 175 (114–272) | 360 (201–450) |
| No anthracyclines | 3099 (53.0) | 13 (11.2) |
| 1 to 100 mg/m2 | 491 (8.4) | 21 (18.1) |
| 100 to 250 mg/m2 | 1402 (24.0) | 33 (28.4) |
| >250 mg/m2 | 720 (12.3) | 42 (36.2) |
| Missing | 133 (2.3)† | 7 (6.0) |
| Mitoxantrone median dose (IQR) | 40 (20–60) | 45 (20–120) |
| No mitoxantrone | 5660 (96.8) | 103 (88.8) |
| <40 mg/m2 | 81 (1.4) | 6 (5.2) |
| >40 mg/m2 | 58 (1.0) | 6 (5.2) |
| Missing | 46 (0.7)‡ | 1 (0.9) |
| Cyclophosphamide (intravenous) | ||
| None | 3674 (62.8) | 34 (29.3) |
| Any | 2132 (36.5) | 81 (69.8) |
| Unknown | 39 (0.7) | 1 (0.9) |
| Cisplatin | ||
| None | 5363 (91.8) | 103 (88.8) |
| Any | 443 (7.6) | 12 (10.3) |
| Unknown | 39 (0.7) | 1 (0.9) |
| Ifosfamide | ||
| None | 5107 (87.4) | 98 (84.5) |
| Any | 699 (12.0) | 17 (14.7) |
| Unknown | 39 (0.7) | 1 (0.9) |
| Vincristine | ||
| None | 1642 (28.1) | 16 (13.8) |
| Any | 4164 (71.2) | 99 (85.3) |
| Unknown | 39 (0.7) | 1 (0.9) |
| Radiotherapy field involving the heart | ||
| No chest radiotherapy | 4575 (78.3) | 78 (67.2) |
| Radiotherapy potentially involving the heart | 588 (10.1) | 9 (7.8) |
| Radiotherapy involving the heart <20 Gy | 275 (4.7) | 15 (12.9) |
| Radiotherapy involving the heart ≥20 Gy | 363 (6.2) | 14 (12.1) |
| Unknown | 44 (0.7) | 0 (0) |
| Recurrence | ||
| No | 4836 (82.7) | 87 (75.0) |
| Yes | 1009 (17.3) | 29 (25.0) |
| Follow‐up | ||
| Vital status | ||
| Alive | 5278 (90.3) | 87 (75.0) |
| Deceased | 567 (9.7) | 29 (25.0) |
| Attained age (y), median (min‐max) | 27.3 (5.1–65.2) | 23.8 (6.2–48.8) |
| ≤14 | 463 (7.9) | 15 (12.9) |
| 15 to 24 | 1949 (33.4) | 45 (38.8) |
| 25 to 34 | 2000 (34.2) | 38 (32.8) |
| 35 to 44 | 1129 (19.3) | 16 (13.8) |
| 45 to 54 | 267 (4.6) | 2 (1.7) |
| ≥55 | 37 (0.6) | 0 (0) |
| Follow‐up duration from primary cancer diagnosis (y), median (min‐max) | 19.9 (5.0–50.4) | 16.8 (5.0–36.8) |
| >5 to 9 | 480 (8.2) | 21 (18.1) |
| 19 to 10 | 2459 (42.1) | 48 (41.4) |
| 20 to 29 | 1791 (30.6) | 34 (29.3) |
| 30 to 39 | 965 (16.5) | 13 (11.2) |
| ≥40 | 150 (2.6) | 0 (0) |
| Source | ||
| LATER questionnaire | 3056 (52.3) | 58 (50.0) |
| General practitioner questionnaire | 773 (13.2) | 6 (5.2) |
| Medical chart | 2016 (34.5) | 52 (44.8) |
| Cardiac events | ||
| Type of validated symptomatic heart failure | ||
| Grade 3 | 61 (52.5) | 61 (52.5) |
| Grade 4 | 33 (28.5) | 33 (28.5) |
| Grade 5 | 22 (19.0) | 22 (19.0) |
| Other cardiac events | ||
| Cardiac ischemia | 21 (0.4) | 2 (1.7)§ |
| Pericarditis | 13 (0.2) | 1 (0.9)§ |
| Valvular disease | 22 (0.4) | 3 (2.6)§ |
| Arrhythmia | 41 (0.7) | 3 (2.6)§ |
CCS indicates childhood cancer survivor; CNS, central nervous system; CT, chemotherapy; DCOG‐LATER, Dutch Childhood Oncology Group Long‐term outcomes after cancer treatment; ICCC, International Classification of Childhood Cancer; IQR, interquartile range; RT, radiatiotherapy.
*
Percentage of the total DCOG‐LATER cohort.
†
n=94 anthracycline=yes, but dose missing.
‡
n=7 mitoxantrone=yes, but dose missing.
§
Cardiac event before the onset of heart failure.