Long-term radiation therapy-related risk of second primary malignancies in patients with lung cancer

Han, Chang; Wu, Yijun; Kang, Kai; Wang, Zhile; Liu, Zhikai; Zhang, Fuquan

doi:10.21037/jtd-21-915

Cited by 8 publications

(10 citation statements)

References 23 publications

(32 reference statements)

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“…And we found that the risk of second primary gastrointestinal malignancies was increasing after the implementation of radiotherapy. On the other hand, using the data from 1975 to 2011, Han et al have revealed that radiotherapy was considerably related to a low risk of developing SPMs in lung cancer patients, especially second primary prostate cancer and thyroid cancer [ 22 ]. Han et al also showed a significantly increased risk for second primary esophageal carcinoma in lung cancer patients, which was similar to our conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with fully resected NSCLC, another study did not advise routine postoperative radiation [ 21 ]. On the other hand, two cohort studies reported that radiotherapy may result in a lower risk of developing SPM, including prostate cancer and thyroid cancer, among lung cancer patients [ 22 ]. However, it has not been sufficiently addressed whether developing SPMs is a severe adverse event following radiotherapy for lung cancer, based on the sparse and contradictory findings of earlier research.…”

Section: Introductionmentioning

confidence: 99%

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Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study

et al. 2023

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Background The most common form of treatment for non-metastatic lung cancer is surgery-based combination therapy, which may also include adjuvant radiotherapy or chemotherapy. Second primary malignancies (SPMs) are uncommon but significant radiation side effects in patients with resectable lung cancer, and SPMs have not been adequately investigated. Our study aims to assess the correlations of radiotherapy with the development of SPMs in patients with resectable lung cancer. Methods We screened for any primary malignancy that occurred more than five years after the diagnosis of resectable lung cancer. Based on the large cohort of the Surveillance, Epidemiology and End Results database, radiotherapy-correlated risks were estimated using the Poisson regression analysis and the cumulative incidence of SPMs was calculated using Fine-Gray competing risk regression analysis. Results Among the 62,435 patients with non-metastatic lung cancer undergoing surgery, a total of 11,341 (18.16%) patients have received radiotherapy. Our findings indicated that radiotherapy was substantially related to a high risk of main second solid malignancies (RR = 1.21; 95%CI, 1.08 to 1.35) and a negligible risk of main second hematologic malignancies (RR = 1.08; 95%CI, 0.84 to 1.37). With the greatest number of patients, the risk of acquiring a second primary gastrointestinal cancer was the highest overall (RR = 1.77; 95 percent CI, 1.44 to 2.15). The cumulative incidence and standardized incidence ratios of SPMs revealed similar findings. Furthermore, the young and the elderly may be more vulnerable, and the highest risk of acquiring most SPMs was seen more than ten years after lung cancer diagnosis. Additionally, more attention should be paid to the second primary gastrointestinal cancer in young individuals with resectable lung cancer. Conclusion After receiving radiotherapy, an increased risk of developing second primary solid and gastrointestinal cancers was observed for patients with resectable lung cancer. The prevention of SPMs associated with radiotherapy requires further attention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study

et al. 2023

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“…Han et al . performed a population‐based study on long‐term RT‐related risk of developing secondary malignancies in lung cancer patients, and the result showed that higher risk of EC (HR = 1.76, P < 0.001) and lower risk of female breast cancer (HR = 0.65, P = 0.001) were found in primary lung cancer patients with RT after propensity‐score‐matching‐adjusted competing risk regression 17 . However, no risk difference in secondary lung cancer was detected in their study.…”

Section: Discussionmentioning

confidence: 99%

Risk and prognosis of secondary thoracic cancers after radiation therapy for esophageal cancer

Lin

et al. 2023

J of Gastro and Hepatol

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Background and Aim Radiation therapy (RT) is a crucial modality for the local control of esophageal cancer (EC), but the effect of RT on the development of secondary thoracic malignancies is still unclear. This study aims to identify the association between RT for the treatment of primary EC and subsequent secondary thoracic cancer (STC). Methods The primary EC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Fine‐Gray competing risk regression and standardized incidence ratio (SIR) were used to evaluate the radiotherapy‐associated cancer risk. Overall survival (OS) was compared by Kaplan–Meier analysis. Results A total of 40 255 EC patients from the SEER database were identified, of which 17 055 patients (42.37%) did not receive radiotherapy (NRT) and 23 200 patients (57.63%) had been treated with RT. After 12 months of latency, 162 patients (0.95%) in the NRT group and 272 patients (1.17%) in the RT group developed STC. The incidences of the RT group were significantly higher than the NRT group. Patients who have primary EC were at an increased risk of developing STC (SIR = 1.79, 95% CI: 1.63–1.96). The SIR of STC was 1.37 (95% CI: 1.16–1.60) in the NRT group and 2.10 (95% CI: 1.87–2.34) in the RT group. The OS of STC patients in the RT group was significantly lower than the NRT group (P = 0.006). Conclusion The RT for primary EC was associated with higher risks of developing STC than patients unexposed to radiotherapy. The EC patients treated with RT, especially young patients, require long‐term monitoring of the risk of STC.

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“…Some other studies are designed to assess the frequency of multiple primaries in a specific body part such as gynecologic malignancies, and the colorectal or aerodigestive tracts [11][12][13][14][15][16][17]. The reports evaluating the effect of cancer treatment on the development of second primaries demonstrated that both chemotherapy and radiotherapy can cause secondary primaries [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Patterns of multiple primaries in fortyfour cancer patients: a single-center clinical experience

Duymuş¹,

Köşeci²,

Serindere³

et al. 2023

Oncol Clin Pract

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Introduction. Multiple primaries are defined as the existence of more than one synchronous or metachronous cancer type in the same individual. Due to a longer follow-up time after a primary cancer diagnosis, the likelihood of detection of a second primary is also increased. We report on patterns of multiple primaries in a cohort of cancer patients from a single institution.Material and methods. We identified 44 patients with multiple primaries that were diagnosed, treated, and followed up between March 2011 and January 2022 from our prospectively maintained database at the Hatay Education and Research Hospital Cancer Unit.Results. The median follow-up time was 60 months (range; 3-103). The median time between the diagnosis of the first primary and the second primary was 29 months (range; 0-94). The median OS was 76 months (95% Cl 26.6-125.4) from the first diagnosis and 27 months (95% Cl 0.65-53.4) from the diagnosis of the second primary for the entire cohort. The first diagnosed tumor was localized in the gastrointestinal system in 43.2% of patients and 65.9% of all tumors were adenocarcinoma. The first diagnosed cancer was at an early stage (Stages I and II) in 63.6% of patients. At the staging evaluation of the second primary, 54.5% of patients were found to be in the early stage (Stages I and II) and 45.5% were found to be in the late stage (Stages III and IV).Conclusions. Our study is important as this is the largest cohort study about practical implications of managing multiple primaries. The risk of second and further primaries should be kept in mind in the active follow-up Introduction and surveillance of cancer patients .

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Long-term radiation therapy-related risk of second primary malignancies in patients with lung cancer

Cited by 8 publications

References 23 publications

Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study

Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study

Risk and prognosis of secondary thoracic cancers after radiation therapy for esophageal cancer

Patterns of multiple primaries in fortyfour cancer patients: a single-center clinical experience

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