Radiotherapy combined with chemotherapy increases the risk of herpes zoster in patients with gynecological cancers: a nationwide cohort study

Abstract

Objective: This study aimed to determine the effect of radiotherapy (RT) on the risk of herpes zoster (HZ) in patients with gynecological cancers via a nationwide population-based study. Methods: Based on patient data obtained from the National Health Insurance Research Database, 1928 gynecological cancer patients were identified with 1:1 matching for RT and non-RT cohorts by age, index date, and cancer type. Another cohort consisting of 964 noncancer individuals matched was used as normal control. The incidence of HZ was compared between cancer patients with and without RT. Age, comorbidities, cancer-related surgery and chemotherapy (CT), and cancer type were adjusted as confounders. Results: The risk of HZ in cancer patients was higher than that of non-cancer individuals (14.23 versus 8.34 per 1,000 person-years [PY], the adjusted hazard ratio [aHR]=1.38, p=0.04). In the cancer population, the incidence of HZ for the RT and non-RT cohorts was 20.55 versus 10.23 per 1,000 PY, respectively (aHR=1.68, p=0.01). Age >50 years was an independent factor for developing HZ. The 5-year actuarial incidence for patients receiving neither RT nor CT, RT alone, CT alone, and combined modalities was 5.4%, 6.9%, 3.7%, and 9.9%, respectively (p<0.0001). In the RT cohort, the risk rose rapidly in the first year, becoming steady thereafter. Conclusion: This population-based study showed that gynecological cancer patients receiving RT combined with CT had the highest cumulative risk of HZ. Health care professionals should be aware of the potential toxicities.

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

“…However, we found CT itself had no effect on HZ (aHR: 1.47, p = 0.15), and the synergistic effect of CT was observed only in HN cancer patients who received RT. Contrastingly, in our previous work on gynecological cancer, we established that both CT and RT had significant roles in HZ development [18].…”

Vaccination for herpes zoster in patients with solid tumors: a position paper on the behalf of the Associazione Italiana di Oncologia Medica (AIOM)

“…64 In a population-based study, the authors have demonstrated that gynecological cancer patients receiving RT and CT had the highest cumulative risk of HZ compared with the non-RT group (1.68-fold higher risk of HZ; 95% CI 1.16-2.36, P ¼ 0.009). 65 This increased risk of HZ has also been confirmed in patients with head/neck cancer (18.55 versus 9.06 per 1000 person-years, P ¼ 0.03) and persisted within the first 2 years and then diminished. 66…”

“…In a population-based study, the authors have demonstrated that gynecological cancer patients receiving RT and CT had the highest cumulative risk of HZ compared with the non-RT group (1.68-fold higher risk of HZ; 95% CI 1.16-2.36, P = 0.009). 65 …”

Efficacy of brivudine in the treatment of herpes zoster with diabetes and renal insufficiency following resection of left renal carcinoma: a case report

“…One year after left nephroureterectomy, HZ occurred on the ipsilateral side, possibly due to decreased immunity resulting from various factors, including the operation itself. this case had many risk factors for PHN, including age > 50 years, history of solid tumor, diabetes, and renal insu ciency [11][12][13]. The characteristics of HZ in this patient were obvious prodromal pain, severe pain, a large herpes area, and an underlying disease accompanied by reduced immune function.…”