Background:
Previous studies have noted the incidence of radiation-induced sarcomas (RIS) but have not investigated the relative risk (RR) of developing RIS based on primary tumor organ disease site. By examining data from the Surveillance, Epidemiology, and End Results (SEER) database, we hypothesized that breast cancer would have a higher incidence of RIS compared to seventeen other primary cancer sites.
Methods:
This was a retrospective cohort study that examined patients from SEER registries between 1973 and 2013. We included patients aged 18 years or older who were diagnosed with cancer and those diagnosed with a cancer who subsequently developed a sarcoma. We excluded patients with missing information on initial radiotherapy treatment or stage. RIS was defined as those who developed a secondary sarcoma near the site of their original malignancy and after a 24-month latency period.
Results:
Our patients had a mean age of 60 years and follow up time of 9.2 years. Breast cancer comprised the majority with 693,701(36.8%) patients of which 161 (0.02%) had a secondary sarcoma. Of the 359 patients with secondary sarcomas, 242 (67.4%) had RIS. Breast cancer had the highest number of RIS patients at 126 compared to all combined non-breast cancer sites at 116. The RR of RIS in breast cancer versus 19 other primary cancer sites was 1.21 (CI: 1.01–1.45,
p
< 0.03, adjusted for age at primary diagnosis, gender, and latency).
Conclusions:
Our study demonstrated that breast cancer has a higher risk of developing RIS compared to other solid cancers.
There was a trend toward worsening total bilirubin from baseline (1.3) to 3 months (2.2, P ¼ 0.09) and 6 months (3.3, P ¼ 0.09). No statistical differences were noted in any variables after 9 months with levels returning to baseline. The absorbed Y90 activity delivered was associated with an increase in total bilirubin at three months (P ¼ 0.02), but not thereafter. There were three mortalities which could be attributed to radioembolization-induced liver disease. At 3-month follow-up, 41% of patients had a complete response and 34% had a partial response using mRECIST criteria. One patient underwent liver transplantation and was found to have >90% necrosis of the HCC on explant pathologic analysis. Conclusions: TARE frequently results in tumor responses in patients previously refractory to TACE or bland embolization. Transient deterioration of liver function and clinical scores can be expected but is usually observed to return to baseline after 9 months.
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