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Wilms tumor survivors had nearly threefold higher metabolic syndrome prevalence

Metabolic syndrome affected 18.8% of Wilms tumor survivors versus 7.3% of matched controls, with abdominal radiotherapy emerging as an important risk factor.

RadOncToday · ·2 min read

KEY POINTS

  • This cross-sectional DCCSS-LATER analysis included 265 adult Wilms tumor survivors treated between 1963 and 2002, with a median age of 33.9 years and median follow-up of 29.8 years from diagnosis. Metabolic outcomes were compared in a 1:3 age- and sex-matched analysis with a population reference cohort.
  • Among survivors with complete metabolic-syndrome data, 45/239 (18.8%) met modified NCEP-ATP-III criteria versus 55/751 (7.3%) matched controls, corresponding to an odds ratio of 2.94 (95% CI 1.92–4.49).
  • The excess was driven mainly by dyslipidemia and glucose abnormalities: elevated triglycerides were more frequent with OR 2.39 (95% CI 1.65–3.49), low HDL cholesterol with OR 2.79 (95% CI 2.00–3.91), and elevated fasting glucose with OR 1.67 (95% CI 1.03–2.70). Blood-pressure prevalence was not significantly different from controls.
  • Abdominal radiotherapy had been delivered to 117/265 survivors (44.2%). In univariable analysis, abdominal irradiation was associated with metabolic syndrome, OR 2.42 (95% CI 1.24–4.75), and exposure above 20 Gy showed a stronger association, OR 3.21 (95% CI 1.58–6.51).
  • After adjustment for age and sex, abdominal radiotherapy was no longer significantly associated with the composite metabolic-syndrome endpoint, adjusted OR 1.14 (95% CI 0.50–2.54). However, elevated fasting glucose remained strongly associated with prior abdominal irradiation, adjusted OR 3.14 (95% CI 1.14–9.56).
  • Original radiotherapy plans were available for 97 of 117 abdominally irradiated survivors. NTCP modeling suggested that median doses of roughly 10–20 Gy to abdominal fat, liver, pancreas or contralateral kidney/renal vessels corresponded to an estimated 5% risk of developing a relevant metabolic abnormality at 30 years, increasing toward 25% at approximately 20–30 Gy, depending on the organ and endpoint.
  • These dose estimates come from historical AP/PA two-field radiotherapy, with relatively coarse reconstructed dosimetry and limited event numbers. The paper’s Figure 1 illustrates how pancreas, kidney/renal vessels, liver and intra-abdominal fat were subdivided for organ-specific modeling, emphasizing that several different abdominal tissues may contribute to late metabolic toxicity.

CLINICAL TAKEAWAY

Long-term Wilms tumor survivors appear to carry a substantial metabolic burden, particularly after historical abdominal radiotherapy above approximately 20 Gy. These data support routine metabolic surveillance in irradiated survivors, but the NTCP estimates should be viewed as late-effect risk signals rather than modern treatment constraints, given the historical techniques and observational design.

SOURCE

International Journal of Radiation Oncology, Biology, Physics