Adverse late health outcomes among children treated with 3D radiotherapy techniques: Study design of the Dutch pediatric 3D-RT study

Josien G.M. Beijer*, Judith L. Kok, Geert O. Janssens, Nina Streefkerk, Andrica C.H. de Vries, Cleo Slagter, John H. Maduro, Petra S. Kroon, Martha A. Grootenhuis, Eline van Dulmen-den Broeder, Jacqueline J. Loonen, Markus Wendling, Wim J.E. Tissing, Helena J. van der Pal, Marloes Louwerens, Arjan Bel, Jaap den Hartogh, Margriet van der Heiden-van der Loo, Leontien C.M. Kremer, Jop C. Teepen*Cécile M. Ronckers

*Corresponding author for this work

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Background: Adverse late health outcomes after multimodal treatment for pediatric cancer are diverse and of prime interest. Currently available evidence and survivorship care guidelines are largely based on studies addressing side-effects of two dimensional planned radiotherapy. Aims: The Dutch pediatric 3D-planned radiotherapy (3D-RT) study aims to gain insight in the long-term health outcomes among children who had radiotherapy in the 3D era. Here, we describe the study design, data-collection methods, and baseline cohort characteristics. Methods and Results: The 3D-RT study represents an expansion of the Dutch Childhood Cancer Survivor study (DCCSS) LATER cohort, including pediatric cancer patients diagnosed during 2000–2012, who survived at least 5 years after initial diagnosis and 2 years post external beam radiotherapy. Individual cancer treatment parameters were obtained from medical files. A national infrastructure for uniform collection and archival of digital radiotherapy files (Computed Tomography [CT]-scans, delineations, plan, and dose files) was established. Health outcome information, including subsequent tumors, originated from medical records at the LATER outpatient clinics, and national registry-linkage. With a median follow-up of 10.9 (interquartile range [IQR]: 7.9–14.3) years after childhood cancer diagnosis, 711 eligible survivors were identified. The most common cancer types were Hodgkin lymphoma, medulloblastoma, and nephroblastoma. Most survivors received radiotherapy directed to the head/cranium only, the craniospinal axis, or the abdominopelvic region. Conclusion: The 3D-RT study will provide knowledge on the risk of adverse late health outcomes and radiation-associated dose-effect relationships. This information is valuable to guide follow-up care of childhood cancer survivors and to refine future treatment protocols.

Original languageEnglish
Article numbere1620
JournalCancer Reports
Issue number2
Publication statusPublished - Feb 2023


  • childhood cancer survivors
  • pediatric radiotherapy
  • radiation dose effects
  • side effects
  • study design


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