Regular Article

Health effects of ionising radiation in paediatrics undergoing either cardiac fluoroscopy or modern radiotherapy (The HARMONIC project)

¹ Barcelona Institute for Global Health (ISGlobal), C Rossello 132 Planta 05, Barcelona, 08036 Spain
² Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
³ CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
⁴ University Hospital Essen (UK Essen), Hufelandstrasse 55, Essen 45147, Germany
⁵ Department of Particle Therapy – University Hospital Essen, West German Cancer Centre (WTZ), Hufelandstrasse 55, Essen 45147, Germany
⁶ French National Institute of Health and Medical Research (Inserm), Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
⁷ Paris-Saclay, Paris-Sud University, 91190 Gif-sur-Yvette, Paris, France
⁸ Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Av De La Division Leclerc 31, Fontenay Aux Roses 92260, France
⁹ Population Health Science Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
¹⁰ Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, Mol 2400, Belgium
¹¹ West German Proton Therapy Centre Essen (WPE), Hufelandstr. 55, Essen 45147, Germany
¹² Stockholm University (SU), Universitetsvagen 10, Stockholm 10691, Sweden
¹³ Université de Caen Normandie (UNICAEN), GANIL/CIMAP/ARIA, Esplanade De La Paix, Caen Cedex 5 14032, France
¹⁴ Katholieke Universiteit Leuven (KU Leuven), Oude Markt 13, Leuven 3000, Belgium
¹⁵ Department of Pediatric and Adolescent Medicine, Aarhus University Hospital (AUH), Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
¹⁶ Aarhus University (AU), Nordre Ringgade 1, Aarhus C 8000, Denmark
¹⁷ Commissariat à l’Énergie Atomique & aux Énergies Alternatives (CEA), Rue Leblanc 25, Paris 15 75015, France
¹⁸ Centre Régional François Baclesse (CRFB), Avenue Du General Harris 3, Caen Cedex 5 14076, France
¹⁹ Centre Hospitalier Universitaire d’Angers (CHU Angers), Rue Larrey 4, Angers 49 000, France
²⁰ Gustave Roussy (GR), Rue Camille Desmoulins 39, Villejuif 94805, France
²¹ Leibniz-Institute for Prevention Research & Epidemiology (BIPS), Achterstrasse 30, 28359 Bremen, Germany
²² Faculty of Health Sciences, University of Bremen, Bremen, Germany
²³ Institute of Clinical Physiology – National Research Council (IFC-CNR), Piazzale Aldo Moro 7, Roma 00185, Italy
²⁴ Luxembourg Institute of Science and Technology (LIST), 5 Avenue Des Hauts Fourneaux, Esch Sur Alzette 4362, Luxembourg
²⁵ Princess Maxima Center for Paediatric Oncology (PMC), Heidelberglaan 25, Utrecht 3584 CS, The Netherlands
²⁶ Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical at the Johannes Gutenberg University, Rhabanusstr. 3, Bonifazius Turm A, 55118 Mainz, Germany
²⁷ University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen 9713 GZ, The Netherlands
²⁸ Cancer Registry of Norway, Department of Research, Ullernchausseen 64, 0379 Oslo, Norway
²⁹ Department of Pediatric Cardiology, Oslo University (OUS), Kirkeveien 166, Tarnbygget, Oslo 0450, Norway
³⁰ University of South-Eastern Norway (USN), Kjolnes Ring 56, Porsgrunn 3918, Norway
³¹ Department of Physics and Computational Radiology, Oslo University (OUS), Kirkeveien 166 Tarnbygget, Oslo 0450, Norway
³² University of Zurich (UZH), Ramistrasse 71, Zurich, 8006 Switzerland
³³ National Research Center for Radiation Medicine (NRCRM), Melnikova Street 53, Kyiv, 04050, Ukraine

^* e-mail: isabelle.thierrychef@isglobal.org

Received: 21 December 2022
Revised: 27 March 2023
Accepted: 5 April 2023
Published online: 24 May 2023

Abstract

The use of ionising radiation (IR) for medical diagnosis and treatment procedures has had a major impact on the survival of paediatric patients. Although the benefits of these techniques lead to efficient health care, evaluation of potential associated long-term health effects is required. HARMONIC aims to better understand the increased risk of cancer and non-cancer effects after exposure to medical IR in children with cancer treated with modern external beam radiotherapy (EBRT) – radiation energy in MeV range – and in children with cardiac defects diagnosed and treated with cardiac fluoroscopy procedures (CFP) – radiation energy in keV range. The project investigates, among survivors of paediatric cancer, potential endocrine dysfunction, cardiovascular and neurovascular damage, health-related quality of life and second (and subsequent) primary cancer (SPC). The cardiac component builds a pooled cohort of approximately 90 000 paediatric patients who underwent CFP during childhood and adolescence to investigate cancer risk following exposure to IR and explore the potential effects of conditions predisposing to cancer. HARMONIC develops software tools to allow dose reconstruction in both EBRT and CFP to enable epidemiological investigations and future optimisation of treatments. With the creation of a biobank of blood and saliva samples, HARMONIC aims to provide a mechanistic understanding of radiation-induced adverse health effects and identify potential biomarkers that can predict these effects.