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For: Dee EC, Muralidhar V, King MT, Martin NE, D'Amico AV, Mouw KW, Orio PF, Nguyen PL, Leeman JE. Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques. Radiother Oncol 2021;161:241-250. [PMID: 34171451 DOI: 10.1016/j.radonc.2021.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/28/2022]

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Cited by Other Article(s)

Patel TA, Jain B, Cho HL, Corti C, Vapiwala N, Chino F, Leeman JE, Dee EC. Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting. Clin Oncol (R Coll Radiol) 2024;36:183-192. [PMID: 38184401 DOI: 10.1016/j.clon.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]

Abstract

AIMS

For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT.

MATERIALS AND METHODS

Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted.

RESULTS

Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT.

CONCLUSIONS

In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.

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Cho HL, Murthy V, Mouw KW, D’Amico AV, Nguyen PL, Leeman JE, Dee EC. Second malignancy probabilities in patients with prostate cancer treated with whole pelvis radiation therapy versus prostate only radiation therapy. Prostate 2022;82:1098-1106. [PMID: 35652585 PMCID: PMC9246953 DOI: 10.1002/pros.24362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022]

Abstract

BACKGROUND

Whole pelvic radiation therapy (WPRT) may improve outcomes compared with prostate only radiation therapy (PORT) in some subsets of men with prostate cancer, as in the POP-RT trial. However, there is concern about increased risk of adverse effects with WPRT, including the development of radiation-induced second malignancies (SM). Given the rarity of SM, little is known about relative rates of SM between WPRT and PORT.

METHODS

A retrospective cohort analysis was performed of men with nonmetastatic, node-negative prostate cancer with at least 60 months of follow-up using a national database. SM probabilities were compared in men receiving either WPRT or PORT using multivariable logistic models adjusting for clinical and sociodemographic factors. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up were also conducted.

RESULTS

Of 50,237 patients in the study, 39,338 (78.4%) received PORT, and 10,899 (21.7%) received WPRT. Median follow-up was 106.2 months (interquartile range 82.32-132.25). Crude probabilities of SM were 9.16% for WPRT and 8.88% for PORT. The adjusted odds ratio (AOR) for development of SM with PORT versus WPRT was 1.046 (95% confidence interval 0.968-1.130). Temporal sensitivity analyses by stratifying by year of diagnosis and follow-up length also did not demonstrate any significant difference in rates of SM between WPRT and PORT using AORs with WPRT as the referent.

CONCLUSIONS

Retrospective analysis of over 50,000 patients did not demonstrate an association between WPRT and an increased probability of SM compared to PORT. Given the findings of POP-RT, the use of WPRT may become widespread for certain subsets of men. Thus, our findings could help guide how we counsel patients deciding between WPRT and PORT and suggest the need for prospective assessment of SM risk with WPRT and PORT.

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Francolini G, Ciccone LP, Di Cataldo V, Detti B, Simontacchi G, Loi M, Mangoni M, Desideri I, Meattini I, Livi L. May Different Treatment Volumes and Technical Approaches Have an Impact on Second Malignancies Risk? J Clin Oncol 2021;39:3762-3763. [PMID: 34534000 DOI: 10.1200/jco.21.01790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open

Affiliation(s)

Giulio Francolini Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Lucia Pia Ciccone Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Vanessa Di Cataldo Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Beatrice Detti Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Gabriele Simontacchi Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Mauro Loi Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Monica Mangoni Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Isacco Desideri Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Icro Meattini Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy
Lorenzo Livi Giulio Francolini, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Lucia Pia Ciccone, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Vanessa Di Cataldo, MD, Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA), University of Florence, Florence, Italy; Beatrice Detti, MD, Gabriele Simontacchi, MD, and Mauro Loi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy; Monica Mangoni, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Isacco Desideri, MD, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; and Icro Meattini, MD, and Lorenzo Livi, MD, Azienda Ospedaliero Universitaria Careggi, University of Florence, Radiation Oncology Unit, Florence, Italy, Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy

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Christopher Dee E, Leeman JE. Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques: Reply. Radiother Oncol 2021;165:191-192. [PMID: 34774655 DOI: 10.1016/j.radonc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]

Blanchard P, Zelefsky MJ, Bossi A, Chargari C, Cosset JM. Second malignancy (SM) in prostate cancer patients treated with SBRT and other contemporary radiation techniques. Radiother Oncol 2021;164:251-252. [PMID: 34627937 DOI: 10.1016/j.radonc.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022]