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Scientific Articles   |    
Ionizing Radiation Exposure and the Development of Soft-Tissue Sarcomas in Atomic-Bomb Survivors
Dino Samartzis, DSc, MSc1; Nobuo Nishi, MD, PhD2; John Cologne, PhD3; Sachiyo Funamoto, BS3; Mikiko Hayashi, BA3; Kazunori Kodama, MD, PhD3; Edward F. Miles, MD4; Akihiko Suyama, MD, PhD5; Midori Soda, MD5; Fumiyoshi Kasagi, PhD3
1 Department of Orthopaedics & Traumatology, University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China. E-mail address: dsamartzis@msn.com; dspine@hku.hk
2 National Institute of Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, 162-8636 Tokyo, Japan
3 Departments of Statistics (J.C. and S.F.), Epidemiology (M.H.), Chief Scientist (K.K.), and the Institute of Radiation Epidemiology (F.K.), Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima-city, Hiroshima 732-0815, Japan
4 Department of Radiation Oncology, Box 3085, Duke University Medical Center, Durham, NC 27710
5 Department of Epidemiology, Radiation Effects Research Foundation, 8-6 Nakagawa 1-chrome, Nagasaki-city, Nagasaki 850, Japan
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  • Disclosure statement for author(s): PDF

Investigation performed at the Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Feb 06;95(3):222-229. doi: 10.2106/JBJS.L.00546
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Abstract

Background: 

Very high levels of ionizing radiation exposure have been associated with the development of soft-tissue sarcoma. The effects of lower levels of ionizing radiation on sarcoma development are unknown. This study addressed the role of low to moderately high levels of ionizing radiation exposure in the development of soft-tissue sarcoma.

Methods: 

Based on the Life Span Study cohort of Japanese atomic-bomb survivors, 80,180 individuals were prospectively assessed for the development of primary soft-tissue sarcoma. Colon dose in gray (Gy), the excess relative risk, and the excess absolute rate per Gy absorbed ionizing radiation dose were assessed. Subject demographic, age-specific, and survival parameters were evaluated.

Results: 

One hundred and four soft-tissue sarcomas were identified (mean colon dose = 0.18 Gy), associated with a 39% five-year survival rate. Mean ages at the time of the bombings and sarcoma diagnosis were 26.8 and 63.6 years, respectively. A linear dose-response model with an excess relative risk of 1.01 per Gy (95% confidence interval [CI]: 0.13 to 2.46; p = 0.019) and an excess absolute risk per Gy of 4.3 per 100,000 persons per year (95% CI: 1.1 to 8.9; p = 0.001) were noted in the development of soft-tissue sarcoma.

Conclusions: 

This is one of the largest and longest studies (fifty-six years from the time of exposure to the time of follow-up) to assess ionizing radiation effects on the development of soft-tissue sarcoma. This is the first study to suggest that lower levels of ionizing radiation may be associated with the development of soft-tissue sarcoma, with exposure of 1 Gy doubling the risk of soft-tissue sarcoma development (linear dose-response). The five-year survival rate of patients with soft-tissue sarcoma in this population was much lower than that reported elsewhere.

Level of Evidence: 

Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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