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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Zhang T, He R, Ding X, Zhao M, Wang C, Zhu S, Liao Y, Wang D, Wang H, Guo J, Liu Y, Zhou Z, Gu Z, Hu H. Fullerenols Mitigate Radiation-Induced Myocardial Injury. Adv Healthc Mater 2023; 12:e2300819. [PMID: 37698231 DOI: 10.1002/adhm.202300819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/19/2023] [Indexed: 09/13/2023]
Abstract
Radiation-induced heart disease is a serious side effect of radiation therapy that can lead to severe consequences. However, effective and safe methods for their prevention and treatment are presently lacking. This study reports the crucial function of fullerenols in protecting cardiomyocytes from radiation injury. First, fullerenols are synthesized using a simple base-catalyzed method. Next, the as-prepared fullerenols are applied as an effective free radical scavenger and broad-spectrum antioxidant to protect against X-ray-induced cardiomyocyte injury. Their ability to reduce apoptosis via the mitochondrial signaling pathway at the cellular level is then verified. Finally, it is observed in animal models that fullerenols accumulate in the heart and alleviate myocardial damage induced by X-rays. This study represents a timely and essential analysis of the prevention and treatment of radiological myocardial injury, providing new insights into the applications of fullerenols for therapeutic strategies.
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Affiliation(s)
- Tingjun Zhang
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
- Department of Infectious Diseases, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P. R. China
| | - Rendong He
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P. R. China
| | - Xuefeng Ding
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
- Department of Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P. R. China
| | - Maoru Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Chengyan Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Shuang Zhu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - You Liao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Dongmei Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Hao Wang
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
| | - Junsong Guo
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
| | - Yaping Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Zhonghui Zhou
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
| | - Zhanjun Gu
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Houxiang Hu
- Academician Workstation, Affiliated Hospital of North Sichuan Medical College Nanchong, Nanchong, 637000, P. R. China
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Wang DQ, Zhang N, Dong LH, Zhong YH, Wu HF, Zhong QZ, Jin J, Hou XR, Jing H, Tang Y, Hu C, Song YW, Liu YP, Qi SN, Tang Y, Lu NN, Chen B, Zhai YR, Zhang WW, Li N, Fang H, Li YX, Wang SL. Dose-Volume Predictors for Radiation Esophagitis in Patients With Breast Cancer Undergoing Hypofractionated Regional Nodal Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:186-197. [PMID: 37001764 DOI: 10.1016/j.ijrobp.2023.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Our objective was to assess the incidence and dose-volume predictors of radiation esophagitis (RE) in patients with breast cancer undergoing hypofractionated regional nodal irradiation. METHODS AND MATERIALS Eligible patients who received intensity modulated radiation therapy (RT) at the chest wall, the supraclavicular/infraclavicular fossa, level II axilla, and/or the internal mammary chain after mastectomy were included. The prescribed dose was 43.5 Gy in 15 fractions. RE was evaluated weekly during RT and at 1 and 2 weeks, followed by 3 and 6 months after RT, and was graded according to National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. The esophagus was contoured from the lower border level of the cricoid cartilage to the lower margin of the aortic arch. Esophageal total volume, mean dose, maximum dose, and the relative volumes (RV) and absolute volumes (AV) receiving at least 5 to 45 Gy by 5-Gy increments (RV5-RV45 and AV5-AV45) were evaluated. Univariable and multivariable logistic regression analyses were performed to determine risk factors for RE, and receiver operating characteristic curves were obtained to identify the thresholds of esophageal dosimetric parameters. RESULTS In total, 298 patients were included between May 8, 2020, and January 5, 2022 (minimum post-RT follow-up: 6 months). Grade 2 and 3 RE incidence was 40.9% (122/298) and 0.3% (1/298), respectively. No grade 4 or 5 RE was observed. Esophageal RV20-RV40 and AV35-AV40 were significantly associated with the risk of grade ≥2 RE after adjusting for tumor laterality and internal mammary nodal irradiation. RV25 and AV35 were optimum dose-volume predictors for grade ≥2 RE at thresholds 20% for RV25 (35.9% vs 60.9%; P = .04) and 0.27 mL for AV35 (31.0% vs 54.6%; P = .04). CONCLUSIONS RE is common in patients with breast cancer undergoing hypofractionated regional nodal irradiation. Maintaining the upper esophageal V25 at <20% and V35 at <0.27 mL may decrease the risk of RE.
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Affiliation(s)
- Dan-Qiong Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Zhang
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Li-Hua Dong
- Department of Radiation Oncology, First Hospital, Jilin University, Changchun, China
| | - Ya-Hua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, China
| | - Qiu-Zi Zhong
- Department of Radiation Oncology, Beijing Hospital, Ministry of Health, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiao-Rong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Rui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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4
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Mondragon LL, Lopez HP, Diaz AF, Lio IA, Guzman AO. Beyond the heart in hypofractionated radiotherapy and in the transition from 3D to IMRT/VMAT. Rep Pract Oncol Radiother 2023; 28:478-484. [PMID: 37795223 PMCID: PMC10547416 DOI: 10.5603/rpor.a2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background The knowledge of the risks induced by radiation with hypofractionation regimens has only recently been estimated together with its implementation as a management standard. However, the dose to other risk organs with intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) is not clear, that is why this is only a reference study of radiation doses to organs at risk in hypofractionation in our center. Materials and methods We completed a retrospective and observational analysis of 1398 patients treated with adjuvant hypofractionated radiotherapy from 2015 to 2018, using the clinical records and dose-volume histogram of patients treated with moderate hypofractionated adjuvant radiotherapy. To analyze the institutional experience on the dosimetry of the esophagus and liver as risk organs in the use of moderate adjuvant hypofractionated radiotherapy in breast cancer. Results The dosimetry of the esophagus was 3271 cGy DMax, 177 cGy DMed, 68 cGy D50%, 500 cGy DcMAX with 3D RT and 4124 cGy DMax, 1242 cGy DMed, 934.50 cGy D50%, 3213 cGy DcMAX with IMRT/VMAT and the dosimetry for the liver was for right breast cancer 466 cGy DMed, 102 cGy D50% and 8% V20, for left breast cancer 22 cGy DMed, 6.10 cGy D50% and 0.3% V20. Conclusion The statistically significant differences in irradiation show the lack of consensus on the optimal restrictions in hypofractionation regimens to reduce clinical sequela; consequently, the variability in the specification of each radiation oncologist is observed; standardization in our center can lead to improvement in the quality of treatments.
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Affiliation(s)
- Lorena Lio Mondragon
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Hidralba Pérez Lopez
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Adolfo Fernández Diaz
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Iván Avilés Lio
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Alejandro Olmos Guzman
- Department of Radiotherapy, National Medical Center of Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
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5
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Ramin C, Veiga LHS, Vo JB, Curtis RE, Bodelon C, Aiello Bowles EJ, Buist DSM, Weinmann S, Feigelson HS, Gierach GL, Berrington de Gonzalez A. Risk of second primary cancer among women in the Kaiser Permanente Breast Cancer Survivors Cohort. Breast Cancer Res 2023; 25:50. [PMID: 37138341 PMCID: PMC10155401 DOI: 10.1186/s13058-023-01647-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Breast cancer survivors are living longer due to early detection and advances in treatment and are at increased risk for second primary cancers. Comprehensive evaluation of second cancer risk among patients treated in recent decades is lacking. METHODS We identified 16,004 females diagnosed with a first primary stage I-III breast cancer between 1990 and 2016 (followed through 2017) and survived ≥ 1 year at Kaiser Permanente (KP) Colorado, Northwest, and Washington. Second cancer was defined as an invasive primary cancer diagnosed ≥ 12 months after the first primary breast cancer. Second cancer risk was evaluated for all cancers (excluding ipsilateral breast cancer) using standardized incidence ratios (SIRs), and a competing risk approach for cumulative incidence and hazard ratios (HRs) adjusted for KP center, treatment, age, and year of first cancer diagnosis. RESULTS Over a median follow-up of 6.2 years, 1,562 women developed second cancer. Breast cancer survivors had a 70% higher risk of any cancer (95%CI = 1.62-1.79) and 45% higher risk of non-breast cancer (95%CI = 1.37-1.54) compared with the general population. SIRs were highest for malignancies of the peritoneum (SIR = 3.44, 95%CI = 1.65-6.33), soft tissue (SIR = 3.32, 95%CI = 2.51-4.30), contralateral breast (SIR = 3.10, 95%CI = 2.82-3.40), and acute myeloid leukemia (SIR = 2.11, 95%CI = 1.18-3.48)/myelodysplastic syndrome (SIR = 3.25, 95%CI = 1.89-5.20). Women also had elevated risks for oral, colon, pancreas, lung, and uterine corpus cancer, melanoma, and non-Hodgkin lymphoma (SIR range = 1.31-1.97). Radiotherapy was associated with increased risk for all second cancers (HR = 1.13, 95%CI = 1.01-1.25) and soft tissue sarcoma (HR = 2.36, 95%CI = 1.17-4.78), chemotherapy with decreased risk for all second cancers (HR = 0.87, 95%CI = 0.78-0.98) and increased myelodysplastic syndrome risk (HR = 3.01, 95%CI = 1.01-8.94), and endocrine therapy with lower contralateral breast cancer risk (HR = 0.48, 95%CI = 0.38-0.60). Approximately 1 in 9 women who survived ≥ 1 year developed second cancer, 1 in 13 developed second non-breast cancer, and 1 in 30 developed contralateral breast cancer by 10 years. Trends in cumulative incidence declined for contralateral breast cancer but not for second non-breast cancers. CONCLUSIONS Elevated risks of second cancer among breast cancer survivors treated in recent decades suggests that heightened surveillance is warranted and continued efforts to reduce second cancers are needed.
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Affiliation(s)
- Cody Ramin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA.
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Heather Spencer Feigelson
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, USA
- Division of Genetics and Epidemiology, ICR, London, UK
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Spoor J, Mureau MAM, Hommes J, Rakhorst H, Dassen AE, Oldenburg HSA, Vissers YLJ, Heuts EM, Koppert LB, Zaal LH, van der Hulst RRWJ, Vrancken Peeters MJTFD, Bleiker EMA, van Leeuwen FE. The Areola study: design and rationale of a cohort study on long-term health outcomes in women with implant-based breast reconstructions. Ann Epidemiol 2023; 82:16-25. [PMID: 37028614 DOI: 10.1016/j.annepidem.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/27/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Implant-based breast reconstructions contribute considerably to the quality of life of breast cancer patients. A knowledge gap exists concerning the potential role of silicone breast implants in the development of so called 'breast implant illness' and autoimmune diseases in breast cancer survivors with implant-based reconstructions. Breast implant illness (BII) is a constellation of non-specific symptoms reported by a small group of women with silicone breast implants. METHODS/DESIGN The Areola study is a multi-centre retrospective cohort study with prospective follow-up aiming to assess the risk of BII and autoimmune diseases in female breast cancer survivors with and without silicone breast implants. In this report, we set out the rationale, study design and methodology of this cohort study. The cohort consists of breast cancer survivors who received surgical treatment with implant-based reconstruction in six major hospitals across the Netherlands in the period between 2000 and 2015. As comparison group, a frequency-matched sample of breast cancer survivors without breast implants will be selected. An additional group of women who received breast augmentation surgery in the same years will be selected to compare their characteristics and health outcomes with those of breast cancer patients with implants. All women still alive will be invited to complete a web-based questionnaire covering health-related topics. The entire cohort including deceased women will be linked to population-based databases of Statistics Netherlands. These include a registry of hospital diagnostic codes, a medicines prescription registry and a cause-of-death registry, through which diagnoses of autoimmune diseases will be identified. Outcomes of interest are the prevalence and incidence of BII and autoimmune diseases. In addition, risk factors for the development of BII and autoimmune disorders will be assessed among women with implants. DISCUSSION The Areola study will contribute to the availability of reliable information on the risks of BII and autoimmune diseases in Dutch breast cancer survivors with silicone breast implants. This will inform breast cancer survivors and aid future breast cancer patients and their treating physicians to make informed decisions about reconstructive strategies after mastectomy. REGISTRATION This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).
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Affiliation(s)
- Jonathan Spoor
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Juliëtte Hommes
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente, Enschede, the Netherlands
| | - Anneriet E Dassen
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Laura H Zaal
- Department of Plastic Surgery, Velthuis kliniek, Hilversum, the Netherlands
| | - Rene R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Plastic and Reconstructive Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Sun Q, Chen Y, Li T, Ni B, Zhu X, Xu B, Li J. Risk and prognosis of secondary esophagus cancer after radiotherapy for breast cancer. Sci Rep 2023; 13:3968. [PMID: 36894590 PMCID: PMC9998633 DOI: 10.1038/s41598-023-30812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Although radiation therapy (RT) improves locoregional recurrence and overall survival in breast cancer (BC), it is not yet clear whether RT affects the risk of patients with BC developing second esophageal cancer (SEC). We enrolled patients with BC as their first primary cancer from nine registries in the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2018. Fine-Gray competing risk regressions were assessed to determine the cumulative incidence of SECs. The standardized incidence ratio (SIR) was used to compare the prevalence of SECs among BC survivors to that in the general population of the US. Kaplan-Meier survival analysis was applied to calculate the 10-year overall survival (OS) and cancer-specific survival (CSS) rates for SEC patients. Among the 523,502 BC patients considered herein, 255,135 were treated with surgery and RT, while 268,367 had surgery without radiotherapy. In a competing risk regression analysis, receiving RT was associated with a higher risk of developing an SEC in BC patients than that in the patients not receiving RT (P = .003). Compared to the general population of the US, the BC patients receiving RT showed a greater incidence of SEC (SIR, 1.52; 95% confidence interval [CI], 1.34-1.71, P < .05). The 10-year OS and CSS rates of SEC patients after RT were comparable to those of the SEC patients after no RT. Radiotherapy was related to an increased risk of developing SECs in patients with BC. Survival outcomes for patients who developed SEC after RT were similar to those after no RT.
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Affiliation(s)
- Qianhui Sun
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Pavilion, Xicheng District, Beijing, China
| | - Yunru Chen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Baoyi Ni
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Pavilion, Xicheng District, Beijing, China
| | - Xiaoyu Zhu
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Pavilion, Xicheng District, Beijing, China
| | - Bowen Xu
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Pavilion, Xicheng District, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Jie Li
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Pavilion, Xicheng District, Beijing, China.
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Mohammed Amin SS, Faraj KA, Kamangar TM, Yarahmadi M. Comparison of esophagus dose in breast cancer patients undergoing supraclavicular irradiation with and without esophagus countering. J Cancer Res Ther 2023; 19:S603-S607. [PMID: 38384025 DOI: 10.4103/jcrt.jcrt_771_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 02/23/2024]
Abstract
CONTEXT Esophagus toxicity and the risk of esophageal cancer are linked to radiation dose to the esophagus in breast cancer patients undergoing supraclavicular irradiation. AIMS The aim of this study was to evaluate the impact of esophagus contouring on the dose received in the esophagus in breast cancer patients undergoing supraclavicular irradiation. SETTING AND DESIGN This study included 30 treatment plans for breast cancer patients who received 50 Gy/25 fractions (2 Gy/fraction/day) using 3D-conformal radiation therapy (3D-CRT) to the whole breast or chest wall and supraclavicular. METHODS AND MATERIALS Our study included two groups: the non-sparing group was the treatment plan in which the esophagus was not delineated and the esophagus sparing group was generated, in which the plans were modified to spare the esophagus. The maximum dose, mean dose, and percentage of esophagus volume received, 5, 10, 15, and 20 Gy, respectively (V5, V10, V15, and V20), were used to evaluate both groups. STATISTICAL ANALYSIS One-way analysis of variance was used. A P value <0.05 was considered statistically significant. RESULTS The esophagus sparing group plans show a reduction in the esophageal mean dose Dmean (5.72 ± 5.15) Gy when compared to the non-sparing group (7.83 ± 3.31) Gy. Likewise, the maximum dose, V5, V10, V15, and V20 were reduced in the esophagus sparing group. All dosimetric parameters were significantly higher (P < 0.05) in patients with left breast cancer for both groups. CONCLUSION Our results suggest that it is possible to reduce the dose to the esophagus by considering the esophagus during treatment planning while maintaining plan quality. This reduction could lead to the greatest predicted decrease in acute esophagitis and esophageal cancer.
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Affiliation(s)
- Soma S Mohammed Amin
- Department of Anesthesia, College of Health and Medical Technology in Sulaimani, Sulaimaniyah Polytechnic University, Sulaimaniyah, Iran
| | - Kharman A Faraj
- Department of Physics, College of Science, University of Sulaimani, Sulaimaniyah, Iran
| | - Tara Molanaie Kamangar
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehran Yarahmadi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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10
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Mo Y, Chen M, Wu M, Chen D, Yu J. Postoperative radiotherapy might be a risk factor for second primary lung cancer: A population-based study. Front Oncol 2022; 12:918137. [PMID: 36313722 PMCID: PMC9597700 DOI: 10.3389/fonc.2022.918137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgery is the main curative therapeutic strategy for patients with initial primary lung cancer (IPLC). Most international guidelines recommend regular follow-ups after discharge to monitor patients for tumor recurrence and metastasis. As the overall survival (OS) in patients with lung cancer improves, their risk of secondary primary lung cancer (SPLC) increases. Previous studies on such patients lack separate assessment of different survival outcomes and evaluation of high-risk factors for SPLC. Therefore, we aimed to determine the correlation between high-risk factors and causes of death in patients with SPLC, based on the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We screened the SEER database for patients with IPLC and SPLC from 2004 to 2015 and included only patients who underwent surgery since the IPLC and in whom the cancer was pathologically verified of an International Classification of Diseases grade of 0-3 and to be non-small-cell lung cancer. The standardized incidence ratio (SIR) was calculated between variables and SPLC. Multivariable Cox proportional-hazards regression analyses were conducted to calculate the correlation of different variables with overall survival (OS) and cancer-specific survival (CSS). A competing-risk model was conducted for SPLC. The effect of baseline bias on survival outcomes by performing propensity score matching analysis in a 1: 6 ratio (SPLC: IPLC). RESULTS For patients aged 0-49 years, the overall SIR was higher in older patients, reaching a maximum of 27.74 in those aged 40-49 years, and at 11.63 in patients aged 50-59 years. The overall SIR was higher for patients who were more recently diagnosed with IPLC and increased with time after diagnosis. Male sex, SPLC (hazard ratio, 1.6173; 95% confidence interval, 1.5505-1.6869; P < 0.001), cancer grade III or IV, lower lobe of the lung, advanced stage and postoperative radiotherapy (PORT) were independently detrimental to OS. In terms of CSS, PORT was a high-risk factor. CONCLUSIONS Postoperative radiotherapy is a risk factor for second primary lung cancer and detrimental to overall and cancer-specific survival in patients who had initial primary lung cancer. These data support the need for life-long follow-up of patients who undergo treatment for IPLC to screen for SPLC.
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Affiliation(s)
- You Mo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Minxin Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Meng Wu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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11
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Chen F, Park SL, Wilkens LR, Wan P, Hart SN, Hu C, Yadav S, Couch FJ, Conti DV, de Smith AJ, Haiman CA. Genetic Risk of Second Primary Cancer in Breast Cancer Survivors: The Multiethnic Cohort Study. Cancer Res 2022; 82:3201-3208. [PMID: 35834270 PMCID: PMC9481694 DOI: 10.1158/0008-5472.can-21-4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/24/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
Women who have had breast cancer in the past are at increased risk of developing a second primary cancer (SPC), including second primary breast cancer (SPBC) or a second primary non-breast cancer (SPNBC). In the Multiethnic Cohort (MEC) Study, we conducted a prospective cohort analysis in 3,223 female breast cancer survivors from five racial/ethnic populations (White, African American, Japanese American, Latino, and Native Hawaiian) to assess the association of rare pathogenic variants (PV) in 37 known cancer predisposition genes with risk of SPC. A total of 719 (22.3%) women developed SPC, of which, 323 (10.0%) were SPBC. Germline PVs in BRCA1 (HR, 2.28; 95% CI, 1.11-4.65) and ERCC2 (HR, 3.51; 95% CI, 1.29-9.54) were significantly enriched in women with SPC. In the subtype analysis for SPBC, a significant association of ERCC2 PVs (HR, 5.09; 95% CI, 1.58-16.4) and a suggestive association of BRCA2 PVs (HR, 2.24; 95% CI, 0.91-5.55) were observed. There was also a higher risk of SPNBC in carriers of BRCA1 PVs (HR, 2.98; 95% CI, 1.21-7.36). These results provide evidence that germline PVs in BRCA1, BRCA2, and ERCC2 contribute to the development of SPC in breast cancer survivors. These findings also suggest that compromised DNA repair mechanisms could be a predisposition factor for SPC in patients with breast cancer, supporting the need for closer monitoring of SPC in women carrying PVs in these genes. SIGNIFICANCE This multiethnic study links germline pathogenic variants in BRCA1, BRCA2, and ERCC2 to the development of second primary cancer in breast cancer survivors, providing biological insights and biomarkers to guide patient monitoring.
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Affiliation(s)
- Fei Chen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Public Health, University of Southern California, Los Angeles, California
| | - Sungshim L Park
- Cancer Epidemiology Program, University of Hawaii, Honolulu, Hawaii
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii, Honolulu, Hawaii
| | - Peggy Wan
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Public Health, University of Southern California, Los Angeles, California
| | - Steven N Hart
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Chunling Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Fergus J Couch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David V Conti
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Public Health, University of Southern California, Los Angeles, California
| | - Adam J de Smith
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Public Health, University of Southern California, Los Angeles, California
| | - Christopher A Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Public Health, University of Southern California, Los Angeles, California
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12
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Radiation-Induced Esophageal Cancer: Investigating the Pathogenesis, Management, and Prognosis. Medicina (B Aires) 2022; 58:medicina58070949. [PMID: 35888668 PMCID: PMC9319891 DOI: 10.3390/medicina58070949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
One of the most serious late side effects of irradiation is the promotion of tumorigenesis. Radiation-induced esophageal cancer (RIEC) can arise in a previously irradiated field, mostly in patients previously irradiated for thoracic malignancies such as breast cancer, Hodgkin and non-Hodgkin lymphomas, head and neck cancers, lung cancer, or previous esophageal cancer. RIEC is rare and accounts for less than 1% of all carcinomas of the esophagus. There are little data available in the current literature regarding pathogenesis, diagnosis, treatment, and outcome of esophageal cancer developed in a previously irradiated field. RIEC seems to represent a biologically aggressive disease with a poor prognosis. Although it is difficult to perform radical surgery on a previously irradiated field, R0 resection remains the mainstay of treatment. The use of neoadjuvant and adjuvant chemoradiotherapy remains very helpful in RIEC, similarly to conventional esophageal cancer protocols. The aim of this article is to elucidate this rare but challenging entity.
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13
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Okonogi N, Karasawa K, Nitta Y, Mori Y, Murata K, Wakatsuki M, Tsuji H. Risk of secondary malignancy after radiotherapy for breast cancer: long-term follow-up of Japanese patients with breast cancer. Breast Cancer Res Treat 2022; 194:561-567. [PMID: 35781767 PMCID: PMC9287211 DOI: 10.1007/s10549-022-06644-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/29/2022] [Indexed: 12/27/2022]
Abstract
Purpose There have been very few reports of secondary malignancies after breast cancer treatment in Asia, particularly in Japan. This study aimed to evaluate the risk of secondary malignancies after radiotherapy (RT) in Japanese breast cancer patients. Methods This single-center retrospective study included patients who underwent RT between July 1961 and September 2006 for postoperative breast cancer. A total of 702 patients with a follow-up period of more than 5 years were analyzed. All malignancies observed at more than 5 years after the start of RT were defined as secondary malignancies. To calculate the relative risk (RR) of secondary malignancies, we applied data from the National Cancer Center in Japan. Results The median observation period was 9.7 (interquartile range 7.1–18.2) years. The cumulative person-years of observation were 6879.4. The RR of contralateral breast cancer increased by 1.85-fold (95% confidence interval [CI] 1.05–3.26) among patients compared with that among the general population; however, the difference was not significant (p = 0.053). The RR of secondary malignancies other than breast cancer increased by 2.71-fold (95% CI 1.99–3.70, p < 0.001) among the patients compared with the general population. Even when only malignancies detected more than 10 years after RT were defined as secondary malignancies, the RR of secondary malignancies other than breast cancer was 1.91 (95% CI 1.33–2.73, p < 0.001). Conclusion The incidence of secondary malignancies after RT may be somewhat higher in Japanese patients with breast cancer than in the general population.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Kumiko Karasawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan. .,Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, 8-1 Kawata-chou, Shinjuku, Tokyo, 162-0054, Japan.
| | - Yuki Nitta
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Yasumasa Mori
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
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14
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Xia C, Qin L, Wang Y, Yao L, Shia B, Wu SY. Risk factors and specific cancer types of second primary malignancies in patients with breast cancer receiving adjuvant radiotherapy: a case-control cohort study based on the SEER database. Am J Cancer Res 2022; 12:2744-2756. [PMID: 35812050 PMCID: PMC9251704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with breast cancer can survive and live a long, cancer-free life; however, late complications of treatment, such as second primary malignancies (SPMs), have emerged as a competing cause of death and morbidity. We conducted a long-term population-based cohort study to identify the risk factors for SPMs and specific secondary cancer types after various latency periods of irradiated breast cancer. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) for independent risk factors for SPM. We also calculated the HR of each specific cancer type and the latency time to specific SPMs. The risk of SPM was statistically significantly higher in patients with adjuvant RT than in patients without adjuvant RT (adjusted HR [aHR]: 1.105, 95% CI: 1.013-1.206). Compared with the control group, the case group had significantly increased risks of contralateral breast cancer (aHR: 1.268, 95% CI: 1.112-1.445), lung cancer (aHR: 1.218, 95% CI: 1.049-1.565), and urinary system cancer (aHR: 1.702, 95% CI: 1.140-2.543). Adjuvant RT for breast cancer increases the risk of SPM. Contralateral breast cancer, lung cancer, and bladder cancer were significant SPMs after breast RT, although the cumulative risk of SPM was low, at approximately 6, 10, and 13 cancers per 1000 women with irradiated breasts at latency periods of 5, 10, and 15 years, respectively, after breast RT.
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Affiliation(s)
- Chuanxin Xia
- Chinese Academy of International Trade and Economic CooperationDongcheng, Beijing, China
| | - Lei Qin
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Yinzhi Wang
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Ling Yao
- Chinese Academy of International Trade and Economic CooperationDongcheng, Beijing, China
| | - Benchang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic UniversityNew Taipei City, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical UniversityTaipei, Taiwan
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15
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The risk of increasing tumor malignancy after PET diagnosis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
This manuscript reviews evidences underlying the estimation of risk of malignancy enhancement of advanced aggressive cancers as a result of the gamma radiation emitted by tracers used in PET diagnostics. We conclude that among many cancers, such a phenomenon likely occurs, particularly in tumor cells with an aggressive biology in the advanced stages of their development, e.g. prostate cancer, melanoma and colorectal cancer. Moreover, we surmise based on gathered evidence that fluorine -18 (18F) labeled pharmaceuticals (18F-deoxyglucose and 18F-choline), commonly used in positron emission tomography (PET) can lead to malignancy enhancement of diagnosed cancer, manifesting as accelerated infiltration of the neighboring tissue, accelerated metastasis and/or radio- and chemotherapy resistance. In this review, some suggestions on future studies verifying this concept are also proposed. If our concerns are justified, it might be appropriate in the future to consider this assumption at the stage of deciding whether to undertake PET monitoring in some patients with advanced aggressive cancer.
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16
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Dell'Oro M, Short M, Wilson P, Peukert D, Hua CH, Merchant TE, Bezak E. Lifetime attributable risk of radiation induced second primary cancer from scattering and scanning proton therapy - A model for out-of-field organs of paediatric patients with cranial cancer. Radiother Oncol 2022; 172:65-75. [DOI: 10.1016/j.radonc.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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17
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Nugent TS, Low EZ, Fahy MR, Donlon NE, McCormick PH, Mehigan BJ, Cunningham M, Gillham C, Kavanagh DO, Kelly ME, Larkin JO. Prostate radiotherapy and the risk of secondary rectal cancer-a meta-analysis. Int J Colorectal Dis 2022; 37:437-447. [PMID: 35037077 DOI: 10.1007/s00384-021-04075-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Radiotherapy is being used increasingly in the treatment of prostate cancer. However, ionising radiation may confer a small risk of a radiation-induced secondary malignancy. We aim to assess the risk of rectal cancer following pelvic radiotherapy for prostate cancer. METHODS A search was conducted of the PubMed/MEDLINE, EMBASE and Web of Science databases identifying studies reporting on the risk of rectal cancer following prostatic radiotherapy. Studies must have included an appropriate control group of non-irradiated prostate cancer patients. A meta-analysis was performed to assess the risk of prostatic radiotherapy on subsequent rectal cancer diagnosis. RESULTS In total, 4757 articles were screened with eight studies meeting the predetermined criteria. A total of 796,386 patients were included in this meta-analysis which showed an increased odds ratio (OR) for subsequent rectal cancer in prostate cancer patients treated with radiotherapy compared to those treated by non-radiotherapy means (OR 1.45, 1.07-1.97, p = 0.02). CONCLUSION These findings confirm that prostate radiotherapy significantly increases the risk of subsequent rectal cancer. This risk has implications for treatment selection, surveillance and patient counselling. However, it is crucial that this information is presented in a rational and comprehensible manner that does not disproportionately frighten or deter patients from what might be their most suitable treatment modality.
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Affiliation(s)
- Timothy S Nugent
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland.
| | - Ernest Z Low
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Matthew R Fahy
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Noel E Donlon
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Paul H McCormick
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Brian J Mehigan
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Moya Cunningham
- Department of Radiotherapy, St James's Hospital, Dublin 8, Ireland
| | - Charles Gillham
- Department of Radiotherapy, St James's Hospital, Dublin 8, Ireland
| | - Dara O Kavanagh
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Michael E Kelly
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - John O Larkin
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
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Duane FK, Kerr A, Wang Z, Darby SC, Ntentas G, Aznar MC, Taylor CW. Exposure of the oesophagus in breast cancer radiotherapy: A systematic review of oesophagus doses published 2010-2020. Radiother Oncol 2021; 164:261-267. [PMID: 34626725 DOI: 10.1016/j.radonc.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Breast cancer radiotherapy can increase the risk of subsequent primary oesophageal cancer, with risk increasing according to oesophagus radiation dose. We describe oesophagus exposure from modern breast cancer regimens and discuss the risks of oesophageal cancer for women irradiated recently. MATERIALS AND METHODS A systematic review was undertaken of oesophagus doses from breast cancer radiotherapy regimens published during 2010-2020. Mean and maximum oesophagus doses were described for different target regions irradiated and different radiotherapy techniques. RESULTS In 112 published regimens from 18 countries, oesophagus doses varied with target region. For partial breast irradiation, average mean oesophagus dose was 0.2 Gy (range 0.1-0.4) in four regimens; maximum dose was not reported. For breast or chest wall radiotherapy, average oesophagus doses were mean 1.8 Gy (range 0.1-10.4) in 24 regimens and maximum 6.7 Gy (range 0.4-14.3) in seven regimens. For radiotherapy including a nodal region, average oesophagus doses were higher: mean 11.4 Gy (range <0.1-29.3) in 61 regimens and maximum 34.4 Gy (range 3.4-51.3) in 55 regimens. Average mean oesophagus doses were >10 Gy for intensity modulated nodal radiotherapy, but lower for other node techniques. CONCLUSIONS Mean oesophagus doses from partial breast and breast/chest wall regimens were usually less than 2 Gy, hence radiation-risks will be very small. However, for radiotherapy including lymph nodes, average mean oesophagus dose of 11.4 Gy may nearly double oesophageal cancer risk. Consideration of oesophageal exposure during nodal radiotherapy planning may reduce the risks of radiation-related oesophageal cancer for women irradiated today.
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Affiliation(s)
- Frances K Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.
| | - Amanda Kerr
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhe Wang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, UK
| | - Marianne C Aznar
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Carolyn W Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Wang KY, Newman J, Lee CS, Seetharamu N. Epidemiology and clinicopathological features of lung cancer in patients with prior history of breast cancer. SAGE Open Med 2021; 9:20503121211017757. [PMID: 34104436 PMCID: PMC8155786 DOI: 10.1177/20503121211017757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common malignancy in women, and lung cancer, the leading cause of cancer-related mortality in the United States, is the most common subsequent primary cancer among breast cancer survivors. In this review, we examine the risk factors that cause subsequent primary lung cancer after breast cancer (referred to herein as BCLC patients) as well as the prognostic factors that may affect survival. Notable clinicopathological features include patient characteristics such as age, smoking history, and the presence of EGFR or BRCA mutations, as well as factors related to the treatment of breast cancer such as radiation, surgery, chemotherapy, stage, anti-estrogen therapy, and ER/PR/HER2 status.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northshore University Hospital, Manhasset, NY, USA
| | - James Newman
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
| | - Chung-Shien Lee
- St. John's University College of Pharmacy and Health Sciences, Queens, NY, USA
| | - Nagashree Seetharamu
- Department of Hematology Oncology, Northshore University Hospital, Manhasset, NY, USA
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20
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Novikov SN, Krzhivitskii PI, Melnik YS, Valitova AA, Bryantseva ZV, Akulova IA, Kanaev SV. Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring. Radiat Oncol J 2021; 39:8-14. [PMID: 33794569 PMCID: PMC8024181 DOI: 10.3857/roj.2020.00871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE to determine the localization of sentinel lymph nodes (SLNs) in a large cohort of patients with breast cancer and validate the European Society for Therapeutic Radiology and Oncology (ESTRO), Radiation Therapy Oncology Group (RTOG), and Radiotherapy Comparative Effectiveness (RADCOMP) guidelines on regional lymph node clinical target volume (CTV-LN) delineation. MATERIALS AND METHODS A total of 254 women with cT1-3N0-1M0 breast cancer underwent single-photon emission computed tomography (SPECT-CT) visualization of SLNs after intra- and peritumoral injection of 99mTc-radiocolloids. All SPECT-CT images were fused with reference simulation computed tomography. A 3D atlas of SLNs was created and used for evaluation of CTV-LN defined by contouring guidelines. RESULTS SPECT-CT visualized 532 SLNs that were localized in axillary level I in 67.5%, level II in 15.4%, level III in 7.3%, internal mammary in 8.5%, and supraclavicular in 1.3% cases. The majority of level II-IV and internal mammary SLNs were inside the recommended CTV-LN. Axillary level I SLNs were covered by ESTRO and RTOG contours in 85% and 85% cases, respectively. "Out of contours" SLNs were mostly detected in lateral subgroup of level I LN (18.5%), while 98%-99% of anterior pectoral and central axillary SLNs were covered by CTV-LN. Internal mammary SLNs were visualized in 33 cases and were outside ESTRO and RTOG contours in 3 and 6 observations, respectively. CONCLUSION SPECT-CT atlas of SLNs demonstrated that in most cases ESTRO and RTOG guidelines correctly represented CTV-LNs with the exception of lateral subgroup of SLNs.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Pavel Ivanovich Krzhivitskii
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Yulia Sergeevna Melnik
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Alina Albertovna Valitova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Zhanna Viktorovna Bryantseva
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Irina Alexandrovna Akulova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
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Swati, Chadha VD. Role of epigenetic mechanisms in propagating off-targeted effects following radiation based therapies - A review. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2021; 787:108370. [PMID: 34083045 DOI: 10.1016/j.mrrev.2021.108370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Despite being an important diagnostic and treatment modality, ionizing radiation (IR) is also known to cause genotoxicity and multiple side effects leading to secondary carcinogenesis. While modern cancer radiation therapy has improved patient recovery and enhanced survival rates, the risk of radiation-related adverse effects has become a growing challenge. It is now well-accepted that IR-induced side effects are not exclusively restricted to exposed cells but also spread to distant 'bystander' cells and even to the unexposed progeny of the irradiated cells. These 'off-targeted' effects involve a plethora of molecular events depending on the type of radiation and tumor tissue background. While the mechanisms by which off-targeted effects arise remain obscure, emerging evidence based on the non-mendelian inheritance of various manifestations of them as well as their persistence for longer periods supports a contribution of epigenetic factors. This review focuses on the major epigenetic phenomena including DNA methylation, histone modifications, and small RNA mediated silencing and their versatile role in the manifestation of IR induced off-targeted effects. As short- and long-range communication vehicles respectively, the role of gap junctions and exosomes in spreading these epigenetic-alteration driven off-targeted effects is also discussed. Furthermore, this review emphasizes the possible therapeutic potentials of these epigenetic mechanisms and how beneficial outcomes could potentially be achieved by targeting various signaling molecules involved in these mechanisms.
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Affiliation(s)
- Swati
- Centre for Nuclear Medicine (U.I.E.A.S.T), South Campus, Panjab University, Sector 25, Chandigarh, 160014, India.
| | - Vijayta D Chadha
- Centre for Nuclear Medicine (U.I.E.A.S.T), South Campus, Panjab University, Sector 25, Chandigarh, 160014, India.
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22
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Journy N, Schonfeld SJ, Hauptmann M, Roberti S, Howell RM, Smith SA, Vaalavirta L, Stovall M, van Leeuwen FE, Weathers RE, Hodgson D, Gilbert ES, Berrington de Gonzalez A, Morton LM. Dose-volume effects of breast cancer radiation therapy on the risk of second oesophageal cancer. Radiother Oncol 2020; 151:33-39. [PMID: 32679305 DOI: 10.1016/j.radonc.2020.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/15/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the relationship between oesophagus dose-volume distribution and long-term risk of oesophageal cancer after radiation therapy for breast cancer. MATERIALS AND METHODS In a case-control study nested within a cohort of 289,748 ≥5-year survivors of female breast cancer treated in 1943-2003 in five countries, doses to the second primary cancer (DSPC) and individual dose-volume histograms (DVH) to the entire oesophagus were reconstructed for 252 oesophageal cancer cases and 488 matched controls (median follow-up time: 13, range: 5-37 years). Using conditional logistic regression, we estimated excess odds ratios (EOR) of oesophageal cancer associated with DVH metrics. We also investigated whether DVH metrics confounded or modified DSPC-related -risk estimates. RESULTS Among the DVH metrics evaluated, median dose (Dmedian) to the entire oesophagus had the best statistical performance for estimating risk of all histological types combined (EOR/Gy = 0.071, 95% confidence interval [CI]: 0.018 to 0.206). For squamous cell carcinoma, the most common subtype, the EOR/Gy for Dmedian increased by 31% (95% CI: 3% to 205%) for each increment of 10% of V30 (p = 0.02). Adjusting for DVH metrics did not materially change the EOR/Gy for DSPC, but there was a borderline significant positive interaction between DSPC and V30 (p = 0.07). CONCLUSION This first study investigating the relationship between oesophagus dose-volume distribution and oesophageal cancer risk showed an increased risk per Gy for Dmedian with larger volumes irradiated at high doses. While current techniques allows better oesophagus sparing, constraints applied to Dmedian and V30 could potentially further reduce the risk of oesophageal cancer.
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Affiliation(s)
- Neige Journy
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Laboratory "Radiation Epidemiology & Cancer Survivorship", Gustave Roussy Cancer Campus, Villejuif, France.
| | - Sara J Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Leila Vaalavirta
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rita E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
| | - Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
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23
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Wong G, Lam E, Karam I, Yee C, Drost L, Tam S, Lam H, McCarvell A, McKenzie E, Chow E. The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review. Cancer Treat Res Commun 2020; 24:100185. [PMID: 32593846 DOI: 10.1016/j.ctarc.2020.100185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The influence of cigarette smoking on cancer risk has been well-studied. Similarly, exposure to ionizing radiation from radiotherapy (RT) can produce detrimental effects on an individual's health. In patients administered RT, there has been an observed relationship in other primary carcinomas. The purpose of this systematic review was to summarize the influence of cigarette smoking on outcomes post adjuvant RT in breast cancer patients. METHODS OVID Medline, Cochrane and Embase were searched and 1893 articles were identified. A total of 71 articles were included in the review. Study type, published year and sample size, age, systemic therapies, RT techniques and treatment side effects were collected if available. RESULTS The review found 198 different outcomes which fell into 7 categories and similar outcomes were recorded. 40% of skin reaction outcomes, 50% of cardiovascular outcomes, 71% of reconstruction outcomes, 29% of pulmonary function outcomes, 33% of mortality outcomes and 42% of secondary recurrence outcomes reported significant differences between smokers and non-smokers. None of the articles reported non-smokers to have a higher risk than smokers. CONCLUSION Cigarette smoking can pose a higher risk of post-treatment complications that can influence an individual's quality of life, survival rate and/or recurrence risk. This review further assessed the impact of smoking on various patient outcomes and side-effects in the adjuvant breast RT setting. The information provided in this review suggest that smoking cessation programs would help educate patients to understand their risks of being a current or former smoker when undergoing RT.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Tam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alyson McCarvell
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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24
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The risk for developing a secondary cancer after breast radiation therapy: Comparison of photon and proton techniques. Radiother Oncol 2020; 149:212-218. [PMID: 32464163 DOI: 10.1016/j.radonc.2020.05.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE To compare secondary malignancy risks of modern proton and photon therapy techniques for locally advanced breast cancer. METHODS AND MATERIALS We utilized dosimetric data from 34 [10 photon-VMAT, 10 photon-3DCRT, 14 pencil beam scanning proton (PBS)] breast cancer patients who received comprehensive nodal irradiation. Employing a model based on organ equivalent dose to account for both inhomogeneous organ dose distributions and non-linear functional dose relationships, we estimated excess absolute risk, excess relative risk, and lifetime attributable risk (LAR) for secondary malignancies. The model uses dose distribution, number of fractions, age at exposure, attained age, the linear-quadratic dose response relationship for cell survival, repopulation factor, as well as gender specific age dependencies, and initial slopes of dose response curves. RESULTS The LAR for carcinoma at age 70 was estimated to be up to 3.64% for esophagus with an advantage of 3DCRT over PBS and VMAT. For the ipsilateral lung, risks were lowest for PBS (up to 5.56%), followed by 3DCRT (up to 6.54%) and VMAT (up to 7.7%). For the contralateral lung, there is a clear advantage of 3DCRT and PBS techniques (risk <0.86%) over VMAT (up to 4.4%). The risk for the contralateral breast is negligible for 3DCRT and PBS but was estimated as up to 1.2% for VMAT. Risks for the thyroid are overall negligible. Independently performed comparative treatment plans on 10 patients revealed that the risk for the contralateral lung and breast using VMAT can be more than an order of magnitude higher compared to PBS. Sarcoma risks were estimated as well showing similar trends but were overall lower compared to carcinoma. CONCLUSION Conventional (3DCRT) techniques led to the lowest estimated risks of, thyroid and esophageal secondary cancers while PBS demonstrated a benefit for secondary lung and contralateral breast cancer risks, with the highest risks overall associated with VMAT techniques.
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Dhanushkodi M, Sundersingh S, Krishnamurthy A. Oesophageal Metastasis from Breast Cancer: Mimicker of Primary Oesophageal Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Wang C, Kishan AU, Yu JB, Raldow A, King CR, Iwamoto KS, Chu FI, Steinberg ML, Kupelian PA. Association between Long-Term Second Malignancy Risk and Radiation: A Comprehensive Analysis of the Entire Surveillance, Epidemiology, and End Results Database (1973-2014). Adv Radiat Oncol 2019; 4:738-747. [PMID: 31673667 PMCID: PMC6817555 DOI: 10.1016/j.adro.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/12/2022] Open
Abstract
Purpose Second malignancies (SMs) after radiation therapy are rare but serious sequelae of treatment. This study investigates whether radiation therapy use is associated with changes in baseline SM risk. Methods and Materials We extracted all patients with cancer, with or without SM, in the Surveillance, Epidemiology, and End Results database from 1973 to 2014. Cumulative incidence of SM for patients stratified by radiation therapy status was calculated using a competing risk model, both for the entire cohort and for subgroups based on the primary tumor's anatomic location. Results We identified 2,872,063 patients with cancer, including 761,289 patients who received radiation therapy and 2,110,774 who did not. The SM rate at 20 years for patients receiving radiation therapy versus no radiation therapy was 21.4% versus 18.8%. The relative risk for SM associated with radiation therapy for the overall group was 1.138 at 20 years. The relative risks for SM associated with radiation therapy to malignancies arising from central nervous system and orbits, head and neck, thorax, abdomen, and pelvis at 20 years were 0.704, 1.011, 0.559, 0.646, and 1.106 for men and 0.792, 1.298, 1.265, 0.780, and 0.988 for women, respectively. Conclusions The association between SM and radiation therapy varies with both sex and disease anatomic location, with the largest increase in SM seen in females irradiated to the head and neck region. Overall, the absolute change in SM rates associated with radiation therapy remains small, with differences in various clinical contexts.
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Affiliation(s)
- Chenyang Wang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - James B Yu
- Department of Therapeutic Radiology, Yale New Haven Hospital, New Haven, Connecticut
| | - Ann Raldow
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Christopher R King
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Keisuke S Iwamoto
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Fang-I Chu
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Patrick A Kupelian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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27
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Zhang J, Yao D, Song Y, Pan Y, Zhu L, Bai Y, Xu Y, Zhang J, Shao C. Fractionated irradiation of right thorax induces abscopal damage on testes leading to decline in fertility. Sci Rep 2019; 9:15221. [PMID: 31645625 PMCID: PMC6811594 DOI: 10.1038/s41598-019-51772-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/27/2019] [Indexed: 01/16/2023] Open
Abstract
Radiation-induced abscopal effect (RIAE) may influence radiotherapy efficiency. However, it is unknown whether RIAE triggers abnormal genetic consequence. We present a novel evidence that, when mice were given fractionated irradiation on right thorax, the ultrastructure of blood-testis barrier was damaged in company with apoptosis induction in testes, and the sperm number and vitality were drastically decreased so that both the fertility and the survival of their offspring were reduced. Protein microarray assay and hormone detection showed that some cytokines especially TNF-α, TGF-β and estradiol in the serum of irradiated mice increased to higher levels in consistent with abscopal damage, and this conditioned serum had toxic effect on TM4 cells in vitro. When the mice were fed with cimetidine, the above abscopal responses were significantly attenuated. This study demonstrates in the first time that the thoracic irradiation (Th-IR) induces structural and functional damage in the distal testes and further cause fertility decline of irradiated male mice, which may have important implications in the strategy development of radiotherapy in avoiding abnormal genetic consequence.
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Affiliation(s)
- Junling Zhang
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Dan Yao
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yimeng Song
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yan Pan
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lin Zhu
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yang Bai
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yanwu Xu
- Department of Biochemistry, College of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianghong Zhang
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Chunlin Shao
- Institute of Radiation Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Howell RM, Smith SA, Weathers RE, Kry SF, Stovall M. Adaptations to a Generalized Radiation Dose Reconstruction Methodology for Use in Epidemiologic Studies: An Update from the MD Anderson Late Effect Group. Radiat Res 2019; 192:169-188. [PMID: 31211642 PMCID: PMC8041091 DOI: 10.1667/rr15201.1] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Epidemiologic studies that include patients who underwent radiation therapy for the treatment of cancer aim to quantify the relationship between radiotherapy and the risk of subsequent late effects. Because of the long follow-up period required to observe late effects, these studies are conducted retrospectively. The studies routinely include patients treated across numerous institutions using a wide range of technologies and represent treatments over several decades. As a result, determining the dose throughout the patient's body is uniquely challenging. Therefore, estimating doses throughout the patient's body for epidemiologic studies requires special methodologies that are generally applied to a wide range of radiotherapy techniques. Over ten years ago, the MD Anderson Late Effects Group described various dose reconstruction methods for therapeutic and diagnostic radiation exposure for epidemiologic studies. Here we provide an update to the most widely used dose reconstruction methodology for epidemiologic studies, analytical model calculations combined with a 3D age-specific computational phantom. In particular, we describe the various adaptations (and enhancements) of that methodology, as well as how they have been used in radiation epidemiology studies and may be used in future studies.
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Affiliation(s)
- Rebecca M. Howell
- Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center, Houston, Texas
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29
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Sakata R, Preston DL, Brenner AV, Sugiyama H, Grant EJ, Rajaraman P, Sadakane A, Utada M, French B, Cahoon EK, Mabuchi K, Ozasa K. Radiation-Related Risk of Cancers of the Upper Digestive Tract among Japanese Atomic Bomb Survivors. Radiat Res 2019; 192:331-344. [PMID: 31356146 DOI: 10.1667/rr15386.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As a follow-up to the comprehensive work on solid cancer incidence in the Life Span Study (LSS) cohort of atomic bomb survivors between 1958 and 1998, we report here on updated radiation risk estimates for upper digestive tract cancers. In this study, we added 11 years of follow-up (1958-2009), used improved radiation dose estimates, considered effects of smoking and alcohol consumption and performed dose-response analyses by anatomical sub-site. In examining 52 years'worth of data, we ascertained the occurrence of 394 oral cavity/pharyngeal cancers, 486 esophageal cancers and 5,661 stomach cancers among 105,444 subjects. The radiation risk for oral cavity/pharyngeal cancer, other than salivary gland, was elevated but not significantly so. In contrast, salivary gland cancer exhibited a strong linear dose response with excess relative risk (ERR) of 2.54 per Gy [95% confidence interval (CI): 0.69 to 6.1]. Radiation risk decreased considerably with increasing age at time of exposure (-66% per decade, 95% CI: -88% to -32%). The dose response for esophageal cancer was statistically significant under a simple linear, linear-quadratic and quadratic model. Both linear-quadratic and quadratic models described the data better than a simple linear model and, of the two, the quadratic model showed a marginally better fit based on the Akaike Information Criteria. Sex difference in linear ERRs was not statistically significant; however, when the dose-response shape was allowed to vary by sex, statistically significant curvature was found among males, with no evidence of quadratic departure from linearity among females. The risk for stomach cancer increased significantly with dose and there was little evidence for quadratic departure from linearity among either males or females. The sex-averaged ERR at age 70 was 0.33 per Gy (95% CI: 0.20 to 0.47). The ERR decreased significantly (-1.93 power of attained age, 95% CI: -2.94 to -0.82) with increasing attained age, but not with age at exposure, and was higher in females than males (P = 0.02). Our results are largely consistent with the results of prior LSS analyses. Salivary gland, esophageal and stomach cancers continue to show significant increases in risk with radiation dose. Adjustment for lifestyle factors had almost no impact on the radiation effect estimates. Further follow-up of the LSS cohort is important to clarify the nature of radiation effects for upper digestive tract cancers, especially for oral cavity/pharyngeal and esophageal cancers, for which detailed investigation for dose-response shape could not be conducted due to the small number of cases.
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Affiliation(s)
| | - Dale L Preston
- Departments of Hirosoft International Corporation, Eureka, California
| | | | | | - Eric J Grant
- Departments of Associate Chief of Research, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Preetha Rajaraman
- Departments of Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | | | | | - Elizabeth K Cahoon
- Departments of Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Kiyohiko Mabuchi
- Departments of Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Outcomes of Radiation-Associated Esophageal Squamous Cell Carcinoma: The MSKCC Experience. J Gastrointest Surg 2019; 23:11-22. [PMID: 30215197 PMCID: PMC6572721 DOI: 10.1007/s11605-018-3958-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/29/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Esophageal squamous cell carcinoma (ESCC-R) is a rarely encountered sequela of chest radiation. Treatment is limited by toxicity with reirradiation and complex surgical dissection in a previously radiated field. The clinical presentation, prognosis, and treatment selection of ESCC-R remain undefined. METHODS A retrospective review of patients with esophageal squamous cell carcinoma at a single institution between 2000 and 2017 was performed to identify patients with previous radiation therapy (≥ 5 years delay). Clinicopathologic characteristics, treatment, and outcomes of ESCC-R (n = 69) patients were compared to patients with primary esophageal squamous cell carcinoma (ESCC) (n = 827). Overall survival (OS) and cumulative incidence of recurrence (CIR) were compared using log-rank and Gray's tests, respectively. RESULTS Median time from radiation to ESCC-R was 18.2 years. The majority of ESCC-R patients were female and presented with earlier disease and decreased behavioral risk factors. ESCC-R treated with surgery alone had worse OS than ESCC (5-year 15 vs 33%; p = 0.045). Patients with ESCC-R who received neoadjuvant treatment had higher risk of postoperative in-house mortality (16.7 vs 4.2%; p = 0.032). Patients with ESCC-R treated with surgery alone and definitive chemoradiation had higher recurrence risk than those with neoadjuvant + surgery (5-year recurrence 55 and 45 vs 15%; p = 0.101). CONCLUSION Neoadjuvant chemotherapy or chemoradiation should be used whenever possible for ESCC-R as it is associated with lower risk of recurrence. The improved survival benefits of aggressive treatment must be weighed against the higher associated postoperative risks.
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Exposure of remote organs and associated cancer risks from tangential and multi-field breast cancer radiotherapy. Strahlenther Onkol 2018; 195:32-42. [PMID: 30350118 DOI: 10.1007/s00066-018-1384-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE With the ever-increasing cure rates in breast cancer, radiotherapy-induced cancers have become an important issue. This study aimed to estimate secondary cancer risks for different treatment techniques, taking into account organs throughout the body. MATERIAL AND METHODS Organ doses were evaluated for a tangential three-dimensional conformal (3D-CRT) and a multi-field intensity-modulated radiotherapy (IMRT) plan using a validated, Monte Carlo-based treatment planning system. Effects of wedges and of forward versus inverse planning were systematically investigated on the basis of phantom measurements. Organ-specific cancer risks were estimated using risk coefficients derived from radiotherapy patients or from the atomic bomb survivors. RESULTS In the 3D-CRT plan, mean organ doses could be kept below 1 Gy for more remote organs than the lung, heart, and contralateral breast, and decreased to a few cGy for organs in the lower torso. Multi-field IMRT led to considerably higher mean doses in organs at risk, the difference being higher than 50% for many organs. Likewise, the peripheral radiation burden was increased by external wedges. No difference was observed for forward versus inverse planning. Despite the lower doses, the total estimated secondary cancer risk in more remote organs was comparable to that in the lung or the contralateral breast. For multi-field IMRT it was 75% higher than for 3D-CRT without external wedges. CONCLUSION Remote organs are important for assessment of radiation-induced cancer risk. Remote doses can be reduced effectively by application of a tangential field configuration and a linear accelerator set-up with low head scatter radiation.
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Luo J, Zhang C, Zhan Q, An F, Zhu W, Jiang H, Ma C. Profiling circRNA and miRNA of radiation-induced esophageal injury in a rat model. Sci Rep 2018; 8:14605. [PMID: 30279559 PMCID: PMC6168520 DOI: 10.1038/s41598-018-33038-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/20/2018] [Indexed: 12/26/2022] Open
Abstract
Evidence has also shown that micro ribonucleic acid (miRNA) plays an important role in many cellular processes. However, it is unclear how ionizing radiation causes the miRNA and circular ribonucleic acid (circRNA) expression levels to change and how this change relates to esophageal injury. We analyzed RNA Sequencing (RNA-seq) data from normal esophageal tissue and irradiated esophageal tissues and used computational approaches to identify and characterize differentially expressed miRNAs and circRNAs. We detected 27 miRNAs and 197 circRNAs that had significantly different expression levels after ionizing radiation treatment compared with normal control.Among the 27 miRNAs, 7 miRNAs were down-regulated, and the other 20 were up-regulated. Their target genes were found to be involved in responses to wound, lipid biosynthesis, cell proliferation, cell migration, chemokine activity, hairpin binding, and the cell membrane system. We also found 197 differentially expressed circRNAs in total, of which 87 were up-regulated and 110 were down-regulated. Notably, we found that differentially expressed circRNAs were enriched in cell differentiation, epithelial cell migration, striatum development, protein binding, extracellular exosome, and focal adhesion functions. Of the related processes, sphingolipid metabolism was notable. Many of the differentially expressed circRNAs were involved in sphingolipid metabolism pathways. Cells responded to ionizing radiation (IR) using multiple pathways, which led to sphingolipid metabolism and other immune responses, ultimately leading to esophageal injury.IR-induced esophageal injury is worth studying, especially the dynamic network of circRNA and miRNA. By knowing the regulatory details of related pathways, radiation-related esophageal injury can be prevented, and the efficiency of radiation therapy can be enhanced.
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Affiliation(s)
- Judong Luo
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China.,Medical college of Shandong University, Jinan, China.,Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Changsong Zhang
- Department of Oncology, Changzhou Tumor Hospital, Soochow University, Changzhou, China
| | - Qiang Zhan
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Fangmei An
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Wenyu Zhu
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hua Jiang
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Changsheng Ma
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China. .,Medical college of Shandong University, Jinan, China.
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Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J 2018; 36:85-94. [PMID: 29983028 PMCID: PMC6074073 DOI: 10.3857/roj.2018.00290] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
Radiation-induced second malignancies (RISM) is one of the important late side effects of radiation therapy and has an impact on optimal treatment decision-making. Many factors contribute to the development of RISM such as age at radiation, dose and volume of irradiated area, type of irradiated organ and tissue, radiation technique and individual and family history of cancer. Exact mechanism of RISM is unknown. But nowadays, it is a growing concern in oncology because of the increased number of cancer survivors and efforts are being made to prevent or decrease the incidence of RISM. The primary search for articles was carried via Google Scholar and PubMed with keywords included 'radiation induced malignancies, second malignancies, and chemotherapy induced malignancies'. Additional papers were found through references from relevant articles. In this review article, we have discussed about the pathogenesis, factors contributing to RISM, screening and prevention strategies of RISM.
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Affiliation(s)
| | - Abhash Shankar
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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Abnet CC, Arnold M, Wei WQ. Epidemiology of Esophageal Squamous Cell Carcinoma. Gastroenterology 2018; 154:360-373. [PMID: 28823862 PMCID: PMC5836473 DOI: 10.1053/j.gastro.2017.08.023] [Citation(s) in RCA: 936] [Impact Index Per Article: 156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/11/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) accounts for about 90% of the 456,000 incident esophageal cancers each year. Regions of high incidence include Eastern to Central Asia, along the Rift Valley in East Africa, and into South Africa. There are many causes of ESCC, which vary among regions. Early studies in France associated smoking cigarettes and heavy alcohol consumption with high rates of ESCC, but these factors cannot explain the high incidence in other regions. We discuss other risk factors for ESCC, including polycyclic aromatic hydrocarbons from a variety of sources, high-temperature foods, diet, and oral health and the microbiome-all require further research. A growing list of defined genomic regions affects susceptibility, but large genome-wide association studies have been conducted with ethnic Chinese subjects only; more studies are called for in the rest of Asia and Africa. ESCC has been understudied, but growing infrastructure in more high-incidence countries will allow rapid progress in our understanding.
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Affiliation(s)
- Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Wen-Qiang Wei
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Brodin NP, Kabarriti R, Garg MK, Guha C, Tomé WA. Systematic Review of Normal Tissue Complication Models Relevant to Standard Fractionation Radiation Therapy of the Head and Neck Region Published After the QUANTEC Reports. Int J Radiat Oncol Biol Phys 2017; 100:391-407. [PMID: 29353656 DOI: 10.1016/j.ijrobp.2017.09.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
There has recently been an increasing interest in model-based evaluation and comparison of different treatment options in radiation oncology studies. This is partly driven by the considerable technical advancements in radiation therapy of the last decade, leaving radiation oncologists with a multitude of options to consider. In lieu of randomized trials comparing all of these different treatment options for varying indications, which is unfeasible, treatment evaluations based on normal tissue complication probability (NTCP) models offer a practical alternative. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) effort, culminating in a number of reports published in 2010, provided a basis for many of the since-implemented dose-response models and dose-volume constraints and was a key component for model-based treatment evaluations. Given that 7 years have passed since the QUANTEC publications and that patient-reported outcomes have emerged as an important consideration in recent years, an updated summary of the published radiation dose-response literature, which includes a focus on patient-reported quality of life outcomes, is warranted. Here we provide a systematic review of quantitative dose-response models published after January 1, 2010 for endpoints relevant to radiation therapy for head and neck cancer, because these patients are typically at risk for a variety of treatment-induced normal tissue complications.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Rafi Kabarriti
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Madhur K Garg
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Chandan Guha
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
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36
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Schena M, Battaglia AF, Munoz F. Esophageal cancer developed in a radiated field: can we reduce the risk of a poor prognosis cancer? J Thorac Dis 2017; 9:1767-1771. [PMID: 28839958 PMCID: PMC5542944 DOI: 10.21037/jtd.2017.06.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marina Schena
- 1st Medical Oncology Division, U. Parini Hospital, Aosta, Italy
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Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, Dodwell D, Ewertz M, Gray R, Jagsi R, Pierce L, Pritchard KI, Swain S, Wang Z, Wang Y, Whelan T, Peto R, McGale P. Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials. J Clin Oncol 2017; 35:1641-1649. [PMID: 28319436 PMCID: PMC5548226 DOI: 10.1200/jco.2016.72.0722] [Citation(s) in RCA: 485] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Radiotherapy reduces the absolute risk of breast cancer mortality by a few percentage points in suitable women but can cause a second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy. Methods First, a systematic literature review was performed of lung and heart doses in breast cancer regimens published during 2010 to 2015. Second, individual patient data meta-analyses of 40,781 women randomly assigned to breast cancer radiotherapy versus no radiotherapy in 75 trials yielded rate ratios (RRs) for second primary cancers and cause-specific mortality and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable. Third, the lung or heart ERRs per Gy in the trials and the 2010 to 2015 doses were combined and applied to current smoker and nonsmoker lung cancer and cardiac mortality rates in population-based data. Results Average doses from 647 regimens published during 2010 to 2015 were 5.7 Gy for whole lung and 4.4 Gy for whole heart. The median year of irradiation was 2010 (interquartile range [IQR], 2008 to 2011). Meta-analyses yielded lung cancer incidence ≥ 10 years after radiotherapy RR of 2.10 (95% CI, 1.48 to 2.98; P < .001) on the basis of 134 cancers, indicating 0.11 (95% CI, 0.05 to 0.20) ERR per Gy whole-lung dose. For cardiac mortality, RR was 1.30 (95% CI, 1.15 to 1.46; P < .001) on the basis of 1,253 cardiac deaths. Detailed analyses indicated 0.04 (95% CI, 0.02 to 0.06) ERR per Gy whole-heart dose. Estimated absolute risks from modern radiotherapy were as follows: lung cancer, approximately 4% for long-term continuing smokers and 0.3% for nonsmokers; and cardiac mortality, approximately 1% for smokers and 0.3% for nonsmokers. Conclusion For long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits, yet for most nonsmokers (and ex-smokers), the benefits of radiotherapy far outweigh the risks. Hence, smoking can determine the net effect of radiotherapy on mortality, but smoking cessation substantially reduces radiotherapy risk.
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Affiliation(s)
- Carolyn Taylor
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Candace Correa
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Frances K. Duane
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marianne C. Aznar
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Stewart J. Anderson
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Jonas Bergh
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - David Dodwell
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marianne Ewertz
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Richard Gray
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Reshma Jagsi
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lori Pierce
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kathleen I. Pritchard
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Sandra Swain
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Zhe Wang
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Yaochen Wang
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Tim Whelan
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Richard Peto
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Paul McGale
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - for the Early Breast Cancer Trialists’ Collaborative Group
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Markar SR, Gronnier C, Pasquer A, Duhamel A, Behal H, Théreaux J, Gagnière J, Lebreton G, Brigand C, Meunier B, Collet D, Mariette C. Surgically treated oesophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes. Eur J Cancer 2017; 75:179-189. [PMID: 28236769 DOI: 10.1016/j.ejca.2016.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/21/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objectives of this study were to compare peri-operative and long-term outcomes from oesophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients and (ii) radiotherapy-induced (RIEC) versus non-radiotherapy-induced EC (NRIEC). METHODS Data were collected from 30 European centres from 2000 to 2010. Two thousand four hundred eighty nine EC patients surgically treated were included in the PEC group and 136 in the ECRF group, NRIEC group (n = 61) and RIEC group (n = 75). Propensity score matching analyses were used to compensate for differences in baseline characteristics. RESULTS Compared to the PEC group, the ECRF group was characterised by less use of neoadjuvant chemoradiotherapy (0% versus 29.5%; P < 0.001), less pathological stage III/IV (31.6% versus 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% versus 10.9%; P < 0.001), increased in-hospital mortality (14.0% versus 7.1%; P = 0.003) and overall morbidity (68.4% versus 56.4%, P = 0.006). After matching, 5-year overall (28.8% versus 50.5%; hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15-2.04; P = 0.003) and event-free (32.2% versus 42.5%; HR = 1.56, 95% CI: 1.18-2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumour recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short- or long-term outcomes before and after matching. CONCLUSIONS ECRF is associated with poorer long-term survival related to a reduced utilisation of neoadjuvant chemoradiotherapy and an increased incidence of tumour margin involvement at surgery. Outcomes appear to be dictated by the limitations related to previous radiotherapy administration more than the radiotherapy-induced carcinogenesis.
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Affiliation(s)
- Sheraz R Markar
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Caroline Gronnier
- Univ. Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France; Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France; Inserm, UMR-S 1172, F-59000 Lille, France
| | - Arnaud Pasquer
- Department of Digestive Surgery of Edouard Herriot University Hospital, Lyon, France
| | - Alain Duhamel
- SIRIC OncoLille, France; Univ. Lille, Department of Biostatistics, University Hospital, F-59000 Lille, France
| | - Hélène Behal
- SIRIC OncoLille, France; Univ. Lille, Department of Biostatistics, University Hospital, F-59000 Lille, France
| | | | | | | | | | | | - Denis Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - Christophe Mariette
- Univ. Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000 Lille, France; Univ. Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France; Inserm, UMR-S 1172, F-59000 Lille, France; SIRIC OncoLille, France.
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Charas T, Taggar A, Zelefsky MJ. Second malignancy risk in prostate cancer and radiotherapy. Future Oncol 2017; 13:385-389. [PMID: 28092982 DOI: 10.2217/fon-2016-0503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Tomer Charas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amandeep Taggar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Grantzau T, Overgaard J. Risk of second non-breast cancer among patients treated with and without postoperative radiotherapy for primary breast cancer: A systematic review and meta-analysis of population-based studies including 522,739 patients. Radiother Oncol 2016; 121:402-413. [DOI: 10.1016/j.radonc.2016.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/28/2016] [Accepted: 08/28/2016] [Indexed: 12/20/2022]
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Santos AMC, Marcu LG, Wong CM, Bezak E. Risk estimation of second primary cancers after breast radiotherapy. Acta Oncol 2016; 55:1331-1337. [PMID: 27379458 DOI: 10.1080/0284186x.2016.1185150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS There is evidence towards the induction of second primary cancers (SPCs) after breast radiotherapy (RT). Organs, such as the lungs and the esophagus, have been identified as common sites for SPC formation. As a result, the current study investigated the risk of secondary carcinogenesis associated with particular RT techniques for breast cancer; including whole breast, segmented breast, partial breast and mammosite brachytherapy. METHODS In this study, seven breast cancer patients had all major organs contoured on their planning computed tomography (CT) images. Whole breast, segmented breast, accelerated partial breast irradiation (APBI) and mammosite boost treatment plans were generated for each patient using Pinnacle3 treatment planning system. Differential dose-volume histograms were generated for a number of critical structures: bladder, brain and central nervous system (CNS), breast, colon, liver, lung, mouth and pharynx, esophagus, ovary, salivary gland, small intestine, stomach, and uterus. The lifetime attributed risk (LAR) of cancer induction was estimated using the Schneider et al. excess absolute risk models and dose-volume histograms for the above organs. RESULTS The sites with the highest LAR estimates were the ipsilateral and contralateral lungs, and contralateral breast for all treatment techniques. For all sites, the LAR estimates for the segmented breast and mammosite treatments were lower than those for the whole breast and APBI treatments. For right-sided target volumes the liver also resulted in high LAR estimates, with all techniques having a LAR greater than 20 per 10 000 person-years (PY), except for mammosite with a mean LAR estimate of 13.2 per 10 000 PY. For left-sided target volumes the stomach also resulted in high LAR estimates, with both whole breast and APBI having a LAR greater than 20 per 10 000 PY, and mammosite the lowest with a LAR of 8.3 per 10 000 PY. CONCLUSION It is concluded that the lungs and contralateral breast showed high LAR estimates.
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Affiliation(s)
- Alexandre M. C. Santos
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Loredana G. Marcu
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Faculty of Science, University of Oradea, Oradea, Romania
| | - Chia M. Wong
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- International Centre for Allied Health Evidence and Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Seidel C, Kortmann RD. Rauchen vor und nach der Brustkrebsdiagnose. Strahlenther Onkol 2016; 192:739-40. [DOI: 10.1007/s00066-016-1031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kamran SC, Berrington de Gonzalez A, Ng A, Haas-Kogan D, Viswanathan AN. Therapeutic radiation and the potential risk of second malignancies. Cancer 2016; 122:1809-21. [DOI: 10.1002/cncr.29841] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Sophia C. Kamran
- Harvard Radiation Oncology Program, Harvard Medical School; Boston Massachusetts
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
| | - Andrea Ng
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Daphne Haas-Kogan
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Akila N. Viswanathan
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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Teepen JC, de Vroom SL, van Leeuwen FE, Tissing WJ, Kremer LC, Ronckers CM. Risk of subsequent gastrointestinal cancer among childhood cancer survivors: A systematic review. Cancer Treat Rev 2015; 43:92-103. [PMID: 26827697 DOI: 10.1016/j.ctrv.2015.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at increased risk of developing subsequent malignant neoplasms, including gastrointestinal (GI) cancer. We performed a systematic review to summarize all available literature on the risk of, risk factors for, and outcome after subsequent GI cancer among CCS. METHODS A systematic search of the literature databases Medline/PubMed (1945-2014) and Embase (1947-2014) was performed to identify studies that consisted of ⩾1000 CCS and assessed incidence of or mortality from subsequent GI cancer as an outcome. RESULTS A total of 45 studies were included. Studies that reported risk measures for subsequent GI cancer compared to the general population showed a 3.2 to 9.7-fold elevated risk in cohort studies including all childhood cancer types. Abdominal radiotherapy was associated with an increased risk of subsequent GI cancer in all four studies that assessed this risk. Survivors who had received procarbazine and platinum agents were also suggested to be at increased risk. CONCLUSION Abdominal radiotherapy is a risk factor for developing a subsequent GI cancer. Few studies examined detailed treatment-related risk factors and most studies had small number of GI cancer cases. Therefore, no conclusions could be drawn on the effect of time since childhood cancer on GI cancer risk and on outcome after a subsequent GI cancer. Additional research is necessary to further explore risk factors for and outcome after a subsequent GI cancer, and to systematically evaluate the harms and benefits of GI screening among high-risk survivors in order to give sound screening recommendations.
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Affiliation(s)
- Jop C Teepen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Suzanne L de Vroom
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, P.O. Box 90203, 1066 CX Amsterdam, The Netherlands
| | - Wim J Tissing
- Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Boero IJ, Paravati AJ, Triplett DP, Hwang L, Matsuno RK, Mell LK, Murphy JD. The impact of radiotherapy costs on clinical outcomes in breast cancer. Radiother Oncol 2015; 117:393-9. [PMID: 26472317 DOI: 10.1016/j.radonc.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/05/2015] [Accepted: 10/04/2015] [Indexed: 12/22/2022]
Abstract
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 to 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 $8100 ($6700-9700). 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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Affiliation(s)
- Isabel J Boero
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Anthony J Paravati
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Daniel P Triplett
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Lindsay Hwang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Rayna K Matsuno
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States.
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Davis FG, Krestinina LY, Preston D, Epifanova S, Degteva M, Akleyev AV. Solid Cancer Incidence in the Techa River Incidence Cohort: 1956–2007. Radiat Res 2015; 184:56-65. [DOI: 10.1667/rr14023.1] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Genetic risk of subsequent esophageal cancer in lymphoma and breast cancer long-term survival patients: a pilot study. THE PHARMACOGENOMICS JOURNAL 2015; 16:266-71. [DOI: 10.1038/tpj.2015.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/22/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023]
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Grantzau T, Overgaard J. Second cancers after radiotherapy for early breast cancer. Radiother Oncol 2015; 115:432-3. [DOI: 10.1016/j.radonc.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Morton LM, Gilbert ES, Stovall M, van Leeuwen FE, Dores GM, Lynch CF, Hall P, Smith SA, Weathers RE, Storm HH, Hodgson DC, Kleinerman RA, Joensuu H, Johannesen TB, Andersson M, Holowaty EJ, Kaijser M, Pukkala E, Vaalavirta L, Fossa SD, Langmark F, Travis LB, Lamart S, Simon SL, Fraumeni JF, Aleman BM, Curtis RE. Risk of esophageal cancer following radiotherapy for Hodgkin lymphoma. Haematologica 2015; 99:e193-6. [PMID: 25271315 DOI: 10.3324/haematol.2014.108258] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Ethel S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Graça M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rita E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hans H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - David C Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Ruth A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Michael Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eric J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Magnus Kaijser
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, and School of Health Sciences, University of Tampere, Finland
| | - Leila Vaalavirta
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sophie D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Norway
| | | | - Lois B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, NY, USA
| | - Stephanie Lamart
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Joseph F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Berthe M Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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Boldrin E, Rumiato E, Fassan M, Cappellesso R, Rugge M, Chiarion-Sileni V, Ruol A, Alfieri R, Cagol M, Castoro C, Amadori A, Saggioro D. Genetic features of metachronous esophageal cancer developed in Hodgkin's lymphoma or breast cancer long-term survivors: an exploratory study. PLoS One 2015; 10:e0117070. [PMID: 25611972 PMCID: PMC4303414 DOI: 10.1371/journal.pone.0117070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/18/2014] [Indexed: 01/13/2023] Open
Abstract
Background Development of novel therapeutic drugs and regimens for cancer treatment has led to improvements in patient long-term survival. This success has, however, been accompanied by the increased occurrence of second primary cancers. Indeed, patients who received regional radiotherapy for Hodgkin’s Lymphoma (HL) or breast cancer may develop, many years later, a solid metachronous tumor in the irradiated field. Despite extensive epidemiological studies, little information is available on the genetic changes involved in the pathogenesis of these solid therapy-related neoplasms. Methods Using microsatellite markers located in 7 chromosomal regions frequently deleted in sporadic esophageal cancer, we investigated loss of heterozygosity (LOH) and microsatellite instability (MSI) in 46 paired (normal and tumor) samples. Twenty samples were of esophageal carcinoma developed in HL or breast cancer long-term survivors: 14 squamous cell carcinomas (ESCC) and 6 adenocarcinomas (EADC), while 26 samples, used as control, were of sporadic esophageal cancer (15 ESCC and 11 EADC). Results We found that, though the overall LOH frequency at the studied chromosomal regions was similar among metachronous and sporadic tumors, the latter exhibited a statistically different higher LOH frequency at 17q21.31 (p = 0.018). By stratifying for tumor histotype we observed that LOH at 3p24.1, 5q11.2 and 9p21.3 were more frequent in ESCC than in EADC suggesting a different role of the genetic determinants located nearby these regions in the development of the two esophageal cancer histotypes. Conclusions Altogether, our results strengthen the genetic diversity among ESCC and EADC whether they occurred spontaneously or after therapeutic treatments. The presence of histotype-specific alterations in esophageal carcinoma arisen in HL or breast cancer long-term survivors suggests that their transformation process, though the putative different etiological origin, may retrace sporadic ESCC and EADC carcinogenesis.
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Affiliation(s)
- Elisa Boldrin
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Enrica Rumiato
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology and Cytopathology, University of Padova, Padova, Italy
| | - Rocco Cappellesso
- Department of Medicine, Surgical Pathology and Cytopathology, University of Padova, Padova, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology and Cytopathology, University of Padova, Padova, Italy
| | | | - Alberto Ruol
- Department of Surgical Sciences, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Rita Alfieri
- Oncological Surgery, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Matteo Cagol
- Oncological Surgery, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Carlo Castoro
- Oncological Surgery, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Alberto Amadori
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
- Department of Surgical Sciences, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Daniela Saggioro
- Immunology and Molecular Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
- * E-mail:
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