Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation

Abstract The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term ha...

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Autores principales:	Kang Wang, Zhuyue Li, Xingxing Chen, Jianjun Zhang, Yongfu Xiong, Guochao Zhong, Yang Shi, Qing Li, Xiang Zhang, Hongyuan Li, Tingxiu Xiang, Theodoros Foukakis, Tomas Radivoyevitch, Guosheng Ren
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/8300914d0d4442d3a990b33db2880489
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spelling	oai:doaj.org-article:8300914d0d4442d3a990b33db28804892021-12-02T16:27:08ZRisk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation10.1038/s41523-021-00228-62374-4677https://doaj.org/article/8300914d0d4442d3a990b33db28804892021-03-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00228-6https://doaj.org/toc/2374-4677Abstract The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term have increased risks of secondary hematologic malignancies (SHM), especially for low/intermediate-risk subsets with limited benefits from RT. DCIS patients in Surveillance, Epidemiology, and End Results (SEER) registries (1975–2016) were identified. Relative risks (RR), hazard ratio (HR), and standardized incidence ratios (SIR) were calculated to assess the SHM risk and subsequent survival times. SHM development, defined as a nonsynchronous SHM occurring ≥1 year after DCIS diagnosis, was our primary endpoint. Of 184,363 eligible patients with DCIS, 77,927 (42.3%) in the RT group, and 106,436 (57.7%) in the non-RT group, 1289 developed SHMs a median of 6.4 years (interquartile range, 3.5 to 10.3 years) after their DCIS diagnosis. Compared with DCIS patients in the non-RT group, RT was associated with increased early risk of developing acute lymphoblastic leukemia (ALL; hazard ratio, 3.15; 95% CI, 1.21 to 8.17; P = 0.02), and a delayed risk of non-Hodgkin lymphoma (NHL; hazard ratio, 1.33; 95% CI, 1.09 to 1.62; P < 0.001). This increased risk of ALL and NHL after RT was also observed in subgroup analyses restricted to low/intermediate-risk DCIS. In summary, our data suggest that RT after breast conserving surgery for DCIS patients should be cautiously tailored, especially for low and intermediate-risk patients. Long-term SHM surveillance after DCIS diagnosis is warranted.Kang WangZhuyue LiXingxing ChenJianjun ZhangYongfu XiongGuochao ZhongYang ShiQing LiXiang ZhangHongyuan LiTingxiu XiangTheodoros FoukakisTomas RadivoyevitchGuosheng RenNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Kang Wang Zhuyue Li Xingxing Chen Jianjun Zhang Yongfu Xiong Guochao Zhong Yang Shi Qing Li Xiang Zhang Hongyuan Li Tingxiu Xiang Theodoros Foukakis Tomas Radivoyevitch Guosheng Ren Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
description	Abstract The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term have increased risks of secondary hematologic malignancies (SHM), especially for low/intermediate-risk subsets with limited benefits from RT. DCIS patients in Surveillance, Epidemiology, and End Results (SEER) registries (1975–2016) were identified. Relative risks (RR), hazard ratio (HR), and standardized incidence ratios (SIR) were calculated to assess the SHM risk and subsequent survival times. SHM development, defined as a nonsynchronous SHM occurring ≥1 year after DCIS diagnosis, was our primary endpoint. Of 184,363 eligible patients with DCIS, 77,927 (42.3%) in the RT group, and 106,436 (57.7%) in the non-RT group, 1289 developed SHMs a median of 6.4 years (interquartile range, 3.5 to 10.3 years) after their DCIS diagnosis. Compared with DCIS patients in the non-RT group, RT was associated with increased early risk of developing acute lymphoblastic leukemia (ALL; hazard ratio, 3.15; 95% CI, 1.21 to 8.17; P = 0.02), and a delayed risk of non-Hodgkin lymphoma (NHL; hazard ratio, 1.33; 95% CI, 1.09 to 1.62; P < 0.001). This increased risk of ALL and NHL after RT was also observed in subgroup analyses restricted to low/intermediate-risk DCIS. In summary, our data suggest that RT after breast conserving surgery for DCIS patients should be cautiously tailored, especially for low and intermediate-risk patients. Long-term SHM surveillance after DCIS diagnosis is warranted.
format	article
author	Kang Wang Zhuyue Li Xingxing Chen Jianjun Zhang Yongfu Xiong Guochao Zhong Yang Shi Qing Li Xiang Zhang Hongyuan Li Tingxiu Xiang Theodoros Foukakis Tomas Radivoyevitch Guosheng Ren
author_facet	Kang Wang Zhuyue Li Xingxing Chen Jianjun Zhang Yongfu Xiong Guochao Zhong Yang Shi Qing Li Xiang Zhang Hongyuan Li Tingxiu Xiang Theodoros Foukakis Tomas Radivoyevitch Guosheng Ren
author_sort	Kang Wang
title	Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
title_short	Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
title_full	Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
title_fullStr	Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
title_full_unstemmed	Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
title_sort	risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8300914d0d4442d3a990b33db2880489
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Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation

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