Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study

PurposeExternal Beam Radiotherapy (EBRT) techniques dramatically changed over the years. This may have affected the risk of radiation-induced second primary cancers (SPC), due to increased irradiated low dose volumes and scatter radiation. We investigated whether patterns of SPC after EBRT have changed over the years in prostate cancer (PCa) survivors.Materials and MethodsPCa survivors diagnosed between 1990-2014 were selected from the Netherlands Cancer Registry. Patients treated with EBRT were divided in three time periods, representing 2-dimensional Radiotherapy (RT), 3-dimensional conformal RT (3D-CRT), and the advanced RT (AdvRT) era. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated to estimate relative and excess absolute SPC risks. Sub-hazard ratios (sHRs) were calculated to compare SPC rates between the EBRT and prostatectomy cohort. SPCs were categorized by subsite and anatomic region.ResultsPCa survivors who received EBRT had an increased risk of developing a solid SPC (SIR=1.08; 1.05-1.11), especially in patients aged <70 years (SIR=1.13; 1.09-1.16). Pelvic SPC risks were increased (SIR=1.28; 1.23-1.34), with no obvious differences between the three EBRT eras. Non-pelvic SPC were only significantly increased in the AdvRT era (SIR=1.08; 1.02-1.14), in particular for the 1-5 year follow-up period. Comparing the EBRT cohort to the prostatectomy cohort, again an increased pelvic SPC risk was found for all EBRT periods (sHRs= 1.61, 1.47-1.76). Increased non-pelvic SPC risks were present for all RT eras and highest for the AdvRT period (sHRs=1.17, 1.06-1.29).ConclusionSPC risk in patients with EBRT is increased and remained throughout the different EBRT eras. The risk of developing a SPC outside the pelvic area changed unfavorably in the AdvRT era. Prolonged follow-up is needed to confirm this observation. Whether this is associated with increased irradiated low-dose volumes and scatter, or other changes in clinical EBRT practice, is the subject of further research.

Download Full-text

The Risk of Second Primary Cancers in Prostate Cancer Survivors Treated in the Modern Radiotherapy Era

Frontiers in Oncology ◽

10.3389/fonc.2020.605119 ◽

2020 ◽

Vol 10 ◽

Author(s):

Marie-Christina Jahreiß ◽

Katja K. H. Aben ◽

Mischa S. Hoogeman ◽

Maarten L. P. Dirkx ◽

Kim C. de Vries ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Second Primary ◽

Second Primary Cancers ◽

Prostate Cancer Survivors ◽

Modern Radiotherapy

Download Full-text

The Risk of Second Primary Malignancies up to Three Decades after the Treatment of Differentiated Thyroid Cancer

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-1154 ◽

2008 ◽

Vol 93 (2) ◽

pp. 504-515 ◽

Cited By ~ 221

Author(s):

Aaron. P. Brown ◽

Jergin Chen ◽

Ying J. Hitchcock ◽

Aniko Szabo ◽

Dennis C. Shrieve ◽

...

Keyword(s):

Thyroid Cancer ◽

General Population ◽

Differentiated Thyroid Cancer ◽

Second Primary ◽

Second Primary Cancers ◽

Increased Risk ◽

Absolute Excess Risk ◽

Second Primary Malignancies ◽

Radioisotope Therapy

Abstract Background: The 10-yr survival rate of patients with differentiated thyroid cancer exceeds 90%. These patients may be at elevated risk for secondary cancers. Methods: The risk of nonthyroid second primary malignancies after differentiated thyroid cancer was determined in 30,278 patients diagnosed between 1973 and 2002 from centers participating in the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Median follow-up was 103 months (range, 2–359 months). Risk was further assessed for the addition of radioisotope therapy, gender, latency to development of secondary cancer, and age at thyroid cancer diagnosis. Results: There were 2158 patients who developed a total of 2338 nonthyroid second primary malignancies, significantly more than that expected in the general population [observed/expected (O/E) = 1.09; 95% confidence interval (CI), 1.05–1.14; P < 0.05; absolute excess risk per 10,000 person-years (AER) = 6.39]. A significantly greater risk of second primary malignancies over that expected in the general population was for patients treated with radioisotopes (O/E = 1.20; 95% CI, 1.07–1.33; AER = 11.8) as well as for unirradiated patients (O/E = 1.05; 95% CI, 1.00–1.10; AER = 3.53). However, the increased risk was greater for the irradiated vs. the unirradiated cohort (relative risk = 1.16; 95% CI, 1.05–1.27; P < 0.05). Gender did not affect risk. The greatest risk of second primary cancers occurred within 5 yr of diagnosis and was elevated for younger patients. Conclusions: The overall risk of second primary malignancies is increased for thyroid cancer survivors and varies by radioisotope therapy, latency, and age at diagnosis.

Download Full-text

Racial and ethnic differences in risk of second primary cancers among prostate cancer survivors

Cancer Causes & Control ◽

10.1007/s10552-020-01336-7 ◽

2020 ◽

Vol 31 (11) ◽

pp. 1011-1019

Author(s):

Diana R. Withrow ◽

Sara J. Schonfeld ◽

Rochelle E. Curtis ◽

Lindsay M. Morton ◽

Michael B. Cook ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Ethnic Differences ◽

Second Primary ◽

Second Primary Cancers ◽

Racial And Ethnic Differences ◽

Prostate Cancer Survivors

Download Full-text

Prostate cancer survivors: Risk and mortality in second primary cancers

Cancer Medicine ◽

10.1002/cam4.1764 ◽

2018 ◽

Vol 7 (11) ◽

pp. 5752-5759 ◽

Cited By ~ 6

Author(s):

Subhayan Chattopadhyay ◽

Guoqiao Zheng ◽

Otto Hemminki ◽

Asta Försti ◽

Kristina Sundquist ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Second Primary ◽

Second Primary Cancers ◽

Prostate Cancer Survivors

Download Full-text

Second Primary Cancers in Men With Prostate Cancer: An Increased Risk of Male Breast Cancer

The Journal of Urology ◽

10.1097/01.ju.0000056706.88960.7c ◽

2003 ◽

Vol 169 (4) ◽

pp. 1345-1348 ◽

Cited By ~ 56

Author(s):

CAMILLA THELLENBERG ◽

BEATRICE MALMER ◽

BJÖRN TAVELIN ◽

HENRIK GRÖNBERG

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Male Breast Cancer ◽

Male Breast ◽

Second Primary ◽

Second Primary Cancers ◽

Increased Risk

Download Full-text

LOW-DOSE-RATE OR HIGH-DOSE-RATE BRACHYTHERAPY IN COMBINATION WITH EXTERNAL BEAM RADIOTHERAPY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

Problems in oncology ◽

10.37469/0507-3758-2018-64-1-79-83 ◽

2018 ◽

Vol 64 (1) ◽

pp. 79-83

Author(s):

Vladimir Solodkiy ◽

Andrey Pavlov ◽

Aleksey Tsybulskiy ◽

Anton Ivashin

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Dose Rate ◽

Low Dose ◽

External Beam Radiotherapy ◽

Combined Treatment ◽

High Dose ◽

External Beam ◽

Low Dose Rate ◽

Risk Of Progression

Introduction. One of the main problems of modem on-courology is treatment for prostate cancer of intermediate and high risk of progression. Modern radiotherapy in this category of patients has an advantage over surgical methods of treatment. One way to improve the effectiveness of radiotherapy is to escalate the dose in the prostate gland. For this purpose a combination of brachytherapy and remote radiotherapy is used. This combination allows increasing the dose of radiation, thereby providing better local control, reducing complications from neighboring organs. Purpose of the study. To conduct a comparative analysis of efficacy and safety of radical treatment of patients with prostate cancer at medium and high risk of progression using a combination of high and low dose rate brachytherapy with external beam radiotherapy. Materials and methods. 107 patients with prostate cancer of the group of medium and high risk of progression combined treatment (brachytherapy with external beam radiotherapy) was conducted. 53 patients underwent combined treatment (HDR-brachytherapy and external beam radiotherapy). 54 patients underwent combined treatment (LDR-brachytherapy and external beam radiotherapy). The observation period was 5 years. Conclusion. In a comparative analysis in groups of combined radiotherapy with the use of high-dose and low-dose-rate brachytherapy, the same effectiveness of immediate and long-term results of treatment was demonstrated. A significant reduction in early and late toxic reactions in patients with high-power brachytherapy has been demonstrated.

Download Full-text