Incidence of radiation induced sarcoma attributable to radiotherapy in adults: A retrospective cohort study in the SEER cancer registries across 17 primary tumor sites

Abstract

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.

A Case Report of Post-Radiotherapy <b><i>c-MYC</i></b>-Positive Angiosarcoma of the Breast

“…RIAS is a rare type of secondary angiosarcoma. Recent data from SEER summarized by Snow et al [ 7 ] showed that breast cancer patients had the highest incidence of secondary sarcomas (0.03–0.2%). According to the same authors, considering all post-radiation sarcomas, breast cancer patients have the highest RIS number and account for 52.1% of all radiation-induced sarcomas.…”

127: Radiation-Induced Sarcomas of the Breast: A Review of a 20-Year Single-Centre Experience

“…The cumulative incidence of developing RIS in patients who received radiotherapy was 0.32% at 15 years, compared to 0.23% in patients who did not receive radiotherapy [15]. In a more recent analysis of the SEER database, Snow et al found the incidence of RIS of the breast to be 0.02% at a median follow-up of 9.6 years [11]. A major limitation of SEER data is that it does not report data on radiation treatment or systemic treatment received [11,15].…”

“…In a more recent analysis of the SEER database, Snow et al found the incidence of RIS of the breast to be 0.02% at a median follow-up of 9.6 years [11]. A major limitation of SEER data is that it does not report data on radiation treatment or systemic treatment received [11,15]. The SEER data analysis also excluded patients for whom data were missing, therefore likely underestimating the true incidence.…”

“…Breast cancer patients were found to have the highest incidence of RIS compared to other primary solid cancers in a recent review of SEER data [11]. Hereditary breast cancer syndromes (Li Fraumeni, Retinoblastoma, Nijmegen breakage syndrome) and BRCA are thought to play a role [21].…”

“…Patients who receive radiotherapy for primary breast cancer are known to have a higher incidence of RIS compared to other primary solid cancers [11]. A recent review of Surveillance, Epidemiology, and End Results (SEER) data found an incidence of 0.02% in a population of breast cancer patients diagnosed from 1973 to 2013 [11].…”