Radiation therapy and the risk of herpes zoster in patients with cancer

Abstract

Background The role and impact of radiation therapy (RT) on the development of herpes zoster (HZ) has not been well studied. The objective of this study was to investigate the association between RT and HZ. Methods A propensity score‐matched, retrospective cohort study was conducted using institutional cancer registry data and medical records from 2011 to 2015. The risk of developing HZ in the RT and non‐RT groups was compared using a Cox proportional hazards model. Associations also were explored between the RT field and the anatomic location of HZ in patients who developed HZ after RT. The expected number of HZ events within the radiation field was calculated according to the RT received by each patient; then, this number was compared with the observed number of in‐field events. Results Of 17,655 patients, propensity score matching yielded 4350 pairs; of these, 3891 pairs were eligible for comparison. The cumulative incidence of HZ in the RT group (vs the non‐RT group) during the first 5 years after the index date was 2.1% (vs 0.7%) at 1 year, 3.0% (vs 1.0%) at 2 years, 3.4% (vs 1.3%) at 3 years, 4.1% vs 1.7% at 4 years, and 4.4% vs 1.8% at 5 years. The RT group showed a significantly higher risk of HZ than the non‐RT group (hazard ratio, 2.59, 95% CI, 1.84‐3.66). In the 120 patients who developed HZ after RT, HZ events were observed significantly more frequently within the RT field than expected (74 vs 43.8 events; P < .001). Conclusions Patients with cancer who received RT showed a significantly higher risk of HZ, which was commonly observed within the radiation field.

Hemorrhagic herpes zoster with contralateral multidermatomal distribution associated with rivaroxaban: An unusual presentation

“…Radiation could have been the trigger in our patient's case, but would not be expected to produce a multidermatomal, purpuric eruption. 10 It is the opinion of the authors that this is one of few reported cases of a patient with hemorrhagic herpes zoster associated with rivaroxaban, a selective inhibitor of clotting factor Xa.…”

Incidence and time trends of herpes zoster among patients with head and neck cancer who did and did not undergo radiotherapy: A population-based cohort study

“…A recent research showed that cancer patients receiving RT had a significantly higher risk of HZ (aHR: 2.59) compared with those who did not, particularly within the radiation field. Of note, HN cancers accounted for a small proportion in their cohort, and there was no difference in terms of the risk of HZ between them (18.5 vs. 5.8 per 1000 PYs for RT vs. non-RT group in HN cancers, p = 0.126) [ 9 ]. Another study focusing on patients with Hodgkin’s disease showed that the radiation field mattered.…”

“…Those with hematological malignancies had a higher possibilities of HZ development compared to ones with solid cancers [5][6][7][8]. For patients with a specific cancer diagnosis, the effect of different treatment modalities on risk of HZ has not been well understood [8][9][10].…”

Radiotherapy Increases the Incidence of Herpes Zoster in Oral Cavity Cancer Patients – a National Population-based Cohort Study

“…To the best of our knowledge, this is the first populationbased study to investigate the relationship between radiotherapy and the incidence of herpes zoster in oral cavity cancer patients. In 2020 and 2021, there were two articles that investigated the relationship between head and neck cancer and herpes zoster (11,12); however, these studies did not perform a subgroup analysis for oral cavity cancer. The clinical behavior is different in each type of head and neck cancer.…”