Abdominal radiotherapy: a major determinant of metabolic syndrome in nephroblastoma and neuroblastoma survivors

• Published in: PloS one Vol. 7; no. 12; p. e52237
• Main Authors: van Waas, Marjolein, Neggers, Sebastian J C M M, Raat, Hein, van Rij, Caroline M, Pieters, Rob, van den Heuvel-Eibrink, Marry M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.12.2012; Public Library of Science (PLoS)
• Subjects: Abdomen; Abdomen - radiation effects; Abdominal Fat - metabolism; Adipose tissue; Adiposity - physiology; Adolescent; Adult; Biology; Blood; Blood Glucose - metabolism; Blood pressure; Blood Pressure - physiology; Body composition; Body composition (biology); Body Mass Index; Case-Control Studies; Child; Child, Preschool; Cholesterol; Cholesterol tests; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Cross-Sectional Studies; Development and progression; Dual energy X-ray absorptiometry; Dyslipidemias - blood; Dyslipidemias - metabolism; Dyslipidemias - physiopathology; Energy measurement; Fasting - blood; Fatty acids; Fatty Acids, Nonesterified - blood; Female; Females; Follow-Up Studies; Health risk assessment; High density lipoprotein; Hip; Hip - physiology; Humans; Infant; Infant, Newborn; Insulin; Insulin resistance; Insulin Resistance - physiology; Irradiated; Irradiation; Kidney Neoplasms - blood; Kidney Neoplasms - metabolism; Kidney Neoplasms - radiotherapy; Lipoproteins (high density); Lipoproteins (low density); Low density lipoprotein; Low density lipoproteins; Male; Medicine; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - blood; Metabolic Syndrome - etiology; Middle Aged; Mortality; Nephroblastoma; Neuroblastoma; Neuroblastoma - blood; Neuroblastoma - metabolism; Neuroblastoma - radiotherapy; Physiological aspects; Prospective Studies; Radiation; Radiation (Physics); Radiation Injuries - blood; Radiation Injuries - etiology; Radiation therapy; Radiography, Abdominal - methods; Radiotherapy; Radiotherapy - adverse effects; Survivors; Triglycerides; Triglycerides - blood; Type 2 diabetes; Waist Circumference - physiology; Wilms Tumor - blood; Wilms Tumor - metabolism; Wilms Tumor - radiotherapy; Young Adult; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0052237

Reports on metabolic syndrome in nephroblastoma and neuroblastoma survivors are scarce. Aim was to evaluate the occurrence of and the contribution of treatment regimens to the metabolic syndrome. In this prospective study 164 subjects participated (67 adult long-term nephroblastoma survivors (28 females), 36 adult long-term neuroblastoma survivors (21 females) and 61 control subjects (28 females)). Controls were recruited cross-sectionally. Waist and hip circumference as well as blood pressure were measured. Body composition and abdominal fat were assessed by dual energy X-ray absorptiometry (DXA-scan). Laboratory measurements included fasting triglyceride, high density lipoprotein-cholesterol (HDL-C), glucose, insulin, low-density lipoprotein-cholesterol (LDL-C) and free fatty acids (FFA) levels. Median age at follow-up was 30 (range 19-51) years in survivors and 32 (range 18-62) years in controls. Median follow-up time in survivors was 26 (6-49) years. Nephroblastoma (OR = 5.2, P<0.0001) and neuroblastoma (OR 6.5, P<0.001) survivors had more components of the metabolic syndrome than controls. Survivors treated with abdominal irradiation had higher blood pressure, triglycerides, LDL-C, FFA and lower waist circumference. The latter can not be regarded as a reliable factor in these survivors as radiation affects the waist circumference. When total fat percentage was used as a surrogate marker of adiposity the metabolic syndrome was three times more frequent in abdominally irradiated survivors (27.5%) than in non-irradiated survivors (9.1%, P = 0.018). Nephroblastoma and neuroblastoma survivors are at increased risk for developing components of metabolic syndrome, especially after abdominal irradiation. We emphasize that survivors treated with abdominal irradiation need alternative adiposity measurements for assessment of metabolic syndrome.