Risk of treatment-related esophageal cancer among breast cancer survivors

Morton, Lindsay M.; Gilbert, Ethel S.; Hall, Per; Andersson, Michael; Joensuu, Heikki; Vaalavirta, Leila; Dores, Graça M.; Stovall, Marilyn; Holowaty, Eric J.; Lynch, Charles F.; Curtis, Rochelle E.; Smith, Susan A.; Kleinerman, Ruth A.; Kaijser, Magnus; Storm, Hans H.; Pukkala, Eero; Weathers, Rita; Linet, Martha S.; Rajaraman, Preetha; Fraumeni, JosephF.; Brown, Linda Morris; Leeuwen, Flora E. van; Fosså, Sophie D.; Johannesen, Tom Børge; Langmark, Frøydis; Lamart, Stéphanie; Travis, Lois B.; Aleman, Berthe M.P.

doi:10.1093/annonc/mds144

Cited by 79 publications

(71 citation statements)

References 36 publications

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“…Risks were generally linear with dose but with a much lower ERR/Gy than expected based on the Japanese atomic bomb survivors (5–30 fold) (Figure e2). Two recent studies also found clear dose-response relationships for second esophageal and stomach cancer in adulthood cancer survivors (29,30). In the large study of esophageal cancer after breast cancer, risk increased consistently over the range 20–60 Gy.…”

Section: Resultsmentioning

confidence: 79%

Second Solid Cancers After Radiation Therapy: A Systematic Review of the Epidemiologic Studies of the Radiation Dose-Response Relationship

González

Gilbert

Curtis

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

222

154

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Rapid innovation in radiotherapy techniques has resulted in an urgent need for risk projection models for second cancer risks from high-dose radiation exposure, since direct observation of the late-effects of newer treatments will require patient follow-up for a decade or more. However, the patterns of cancer risk after fractionated high-dose radiation are much less well understood than those after lower-dose exposures (0.1–5 gray (Gy)). In particular, there is uncertainty about the shape of the dose-response curve at high doses, and the magnitude of the second cancer risk per unit dose. We reviewed the available evidence from epidemiologic studies of second solid cancers in organs that received high-dose exposure (>5Gy) from radiotherapy where dose-response curves were estimated from individual organ-specific doses. We included 28 eligible studies with 3,434 second cancer patients across 11 second solid cancers. Overall, there was little evidence that the dose-response curve was non-linear in the direction of a down-turn in risk, even at organ doses of ≥60Gy. Thyroid cancer was the only exception with evidence of a downturn after 20Gy. Generally the excess relative risk per Gy, taking account of age and sex, was 5–10 times lower than the risk from acute exposures of <2Gy among the Japanese atomic bomb survivors. However, the magnitude of the reduction in risk varied according to second cancer. The results from our review provide insights into radiation carcinogenesis from fractionated high-dose exposures, and are generally consistent with current theoretical models. The results can be used to refine the development of second solid cancer risk projection models for novel radiotherapy techniques.

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Section: Resultsmentioning

confidence: 79%

Second Solid Cancers After Radiation Therapy: A Systematic Review of the Epidemiologic Studies of the Radiation Dose-Response Relationship

González

Gilbert

Curtis

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

222

154

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“…Combining our study results with the only other study of esophageal cancer with radiation dose reconstruction to the esophageal tumor (following radiotherapy for breast cancer) 9 yielded a pooled EOR/Gy of 0.10 (95%CI: 0.05-0.18; Phomogeneity=0.202). These two studies substantially expand the evidence for a link between ionizing radiation exposure and esophageal cancer 10 and complement previous studies of esophageal cancer in populations exposed to lower radiation doses, including patients treated for ankylosing spondylitis (ERR/Gy=0.17; 95%CI: 0.09-0.25) 11 and Japanese atomic bomb survivors (ERR/Gy=0.52; 90%CI: 0.15-1.0).…”

Section: *Includes Lymphocyte Depleted Hl (1 Case) Hodgkin Granulomamentioning

confidence: 67%

“…Lindsay M. Morton, 1 Ethel S. Gilbert, 1 Marilyn Stovall, 2 Flora E. van Leeuwen, 3 Graça M. Dores, 1,4 Charles F. Lynch, 5 Per Hall, 6 Susan A. Smith, 2 Rita E. Weathers, 2 Hans H. Storm, 7 David C. Hodgson,8 Ruth A. Kleinerman, 1 Heikki Joensuu, 9 Tom Børge Johannesen, 10 Michael Andersson, 11 Eric J. Holowaty, 12 Magnus Kaijser, 13 Eero Pukkala, 14 Leila Vaalavirta, 9 Sophie D. Fossa, 15 Frøydis Langmark, 10 Lois B. Travis, 16 Stephanie Lamart, 1 …”

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confidence: 99%

Risk of esophageal cancer following radiotherapy for Hodgkin lymphoma

et al. 2014

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“…Known radiation side effects were identified from current literature[15-17]. Outcomes evaluated included cardiac toxicities (myocardial infarction, coronary artery disease, congestive heart failure, electrical abnormalities, pericarditis, valvular disease, cardiomyopathy), skin toxicities (breast deformity, fat necrosis, mastodynia, capsular contracture), radiation pneumonitis, closed rib fracture, and brachial plexopathy.…”

Section: Methodsmentioning

confidence: 99%

The impact of radiotherapy costs on clinical outcomes in breast cancer

Boero

Paravati

Triplett

et al. 2015

Radiotherapy and Oncology

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Background and Purpose In cost-effective healthcare systems, the cost of services should parallel patient complexity or quality of care. The purpose of this study was to determine whether the cost of radiotherapy correlates with patient-related outcomes among a large cohort of breast cancer patients treated with adjuvant breast radiation. Materials and Methods 23,127 women with non-metastatic breast cancer undergoing radiotherapy after breast conservation surgery were identified from the Surveillance, Epidemiology, and End Results database from 2000-2009. Medicare reimbursements were used as a proxy for cost of radiotherapy, and Medicare claims were examined to identify local toxicities, and breast cancer-related endpoints. The impact of cost on these outcomes was studied with multivariable Fine-Gray models to account for competing risks. Results The median cost (and interquartile range) of a course of breast radiation was $8,100 ($6,700-$9,700). Increased radiation costs were not associated with the occurrence of treatment-related toxicities (all p-values > 0.05), ipsilateral breast recurrence (p=0.55), or breast cancer-related mortality (p=0.55). Conclusion Higher costs for adjuvant radiation in breast cancer were not associated with a decreased risk of patient-related outcomes, suggesting inefficiency in Medicare reimbursements. Future efforts should focus on prospective evaluation of alternative payment models for radiotherapy.

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Risk of treatment-related esophageal cancer among breast cancer survivors

Cited by 79 publications

References 36 publications

Second Solid Cancers After Radiation Therapy: A Systematic Review of the Epidemiologic Studies of the Radiation Dose-Response Relationship

Second Solid Cancers After Radiation Therapy: A Systematic Review of the Epidemiologic Studies of the Radiation Dose-Response Relationship

Risk of esophageal cancer following radiotherapy for Hodgkin lymphoma

The impact of radiotherapy costs on clinical outcomes in breast cancer

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