Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study

PurposeExternal Beam Radiotherapy (EBRT) techniques dramatically changed over the years. This may have affected the risk of radiation-induced second primary cancers (SPC), due to increased irradiated low dose volumes and scatter radiation. We investigated whether patterns of SPC after EBRT have chan...

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Autores principales:	Marie-Christina Jahreiß, Wilma D. Heemsbergen, Bo van Santvoort, Mischa Hoogeman, Maarten Dirkx, Floris J. Pos, Tomas Janssen, Andre Dekker, Ben Vanneste, Andre Minken, Carel Hoekstra, Robert J. Smeenk, Inge M. van Oort, Chris H. Bangma, Luca Incrocci, Katja K. H. Aben
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	prostate cancer second primary cancer survivorship advanced external beam radiotherapy three-dimensional conformal radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/e94401e37f50411fad083642701633c0
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spelling	oai:doaj.org-article:e94401e37f50411fad083642701633c02021-12-01T07:48:39ZImpact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study2234-943X10.3389/fonc.2021.771956https://doaj.org/article/e94401e37f50411fad083642701633c02021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.771956/fullhttps://doaj.org/toc/2234-943XPurposeExternal Beam Radiotherapy (EBRT) techniques dramatically changed over the years. This may have affected the risk of radiation-induced second primary cancers (SPC), due to increased irradiated low dose volumes and scatter radiation. We investigated whether patterns of SPC after EBRT have changed over the years in prostate cancer (PCa) survivors.Materials and MethodsPCa survivors diagnosed between 1990-2014 were selected from the Netherlands Cancer Registry. Patients treated with EBRT were divided in three time periods, representing 2-dimensional Radiotherapy (RT), 3-dimensional conformal RT (3D-CRT), and the advanced RT (AdvRT) era. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated to estimate relative and excess absolute SPC risks. Sub-hazard ratios (sHRs) were calculated to compare SPC rates between the EBRT and prostatectomy cohort. SPCs were categorized by subsite and anatomic region.ResultsPCa survivors who received EBRT had an increased risk of developing a solid SPC (SIR=1.08; 1.05-1.11), especially in patients aged <70 years (SIR=1.13; 1.09-1.16). Pelvic SPC risks were increased (SIR=1.28; 1.23-1.34), with no obvious differences between the three EBRT eras. Non-pelvic SPC were only significantly increased in the AdvRT era (SIR=1.08; 1.02-1.14), in particular for the 1-5 year follow-up period. Comparing the EBRT cohort to the prostatectomy cohort, again an increased pelvic SPC risk was found for all EBRT periods (sHRs= 1.61, 1.47-1.76). Increased non-pelvic SPC risks were present for all RT eras and highest for the AdvRT period (sHRs=1.17, 1.06-1.29).ConclusionSPC risk in patients with EBRT is increased and remained throughout the different EBRT eras. The risk of developing a SPC outside the pelvic area changed unfavorably in the AdvRT era. Prolonged follow-up is needed to confirm this observation. Whether this is associated with increased irradiated low-dose volumes and scatter, or other changes in clinical EBRT practice, is the subject of further research.Marie-Christina JahreißWilma D. HeemsbergenBo van SantvoortMischa HoogemanMaarten DirkxFloris J. PosTomas JanssenAndre DekkerBen VannesteAndre MinkenCarel HoekstraRobert J. SmeenkInge M. van OortChris H. BangmaLuca IncrocciKatja K. H. AbenKatja K. H. AbenFrontiers Media S.A.articleprostate cancersecond primary cancersurvivorshipadvanced external beam radiotherapythree-dimensional conformal radiotherapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	prostate cancer second primary cancer survivorship advanced external beam radiotherapy three-dimensional conformal radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	prostate cancer second primary cancer survivorship advanced external beam radiotherapy three-dimensional conformal radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Marie-Christina Jahreiß Wilma D. Heemsbergen Bo van Santvoort Mischa Hoogeman Maarten Dirkx Floris J. Pos Tomas Janssen Andre Dekker Ben Vanneste Andre Minken Carel Hoekstra Robert J. Smeenk Inge M. van Oort Chris H. Bangma Luca Incrocci Katja K. H. Aben Katja K. H. Aben Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
description	PurposeExternal Beam Radiotherapy (EBRT) techniques dramatically changed over the years. This may have affected the risk of radiation-induced second primary cancers (SPC), due to increased irradiated low dose volumes and scatter radiation. We investigated whether patterns of SPC after EBRT have changed over the years in prostate cancer (PCa) survivors.Materials and MethodsPCa survivors diagnosed between 1990-2014 were selected from the Netherlands Cancer Registry. Patients treated with EBRT were divided in three time periods, representing 2-dimensional Radiotherapy (RT), 3-dimensional conformal RT (3D-CRT), and the advanced RT (AdvRT) era. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated to estimate relative and excess absolute SPC risks. Sub-hazard ratios (sHRs) were calculated to compare SPC rates between the EBRT and prostatectomy cohort. SPCs were categorized by subsite and anatomic region.ResultsPCa survivors who received EBRT had an increased risk of developing a solid SPC (SIR=1.08; 1.05-1.11), especially in patients aged <70 years (SIR=1.13; 1.09-1.16). Pelvic SPC risks were increased (SIR=1.28; 1.23-1.34), with no obvious differences between the three EBRT eras. Non-pelvic SPC were only significantly increased in the AdvRT era (SIR=1.08; 1.02-1.14), in particular for the 1-5 year follow-up period. Comparing the EBRT cohort to the prostatectomy cohort, again an increased pelvic SPC risk was found for all EBRT periods (sHRs= 1.61, 1.47-1.76). Increased non-pelvic SPC risks were present for all RT eras and highest for the AdvRT period (sHRs=1.17, 1.06-1.29).ConclusionSPC risk in patients with EBRT is increased and remained throughout the different EBRT eras. The risk of developing a SPC outside the pelvic area changed unfavorably in the AdvRT era. Prolonged follow-up is needed to confirm this observation. Whether this is associated with increased irradiated low-dose volumes and scatter, or other changes in clinical EBRT practice, is the subject of further research.
format	article
author	Marie-Christina Jahreiß Wilma D. Heemsbergen Bo van Santvoort Mischa Hoogeman Maarten Dirkx Floris J. Pos Tomas Janssen Andre Dekker Ben Vanneste Andre Minken Carel Hoekstra Robert J. Smeenk Inge M. van Oort Chris H. Bangma Luca Incrocci Katja K. H. Aben Katja K. H. Aben
author_facet	Marie-Christina Jahreiß Wilma D. Heemsbergen Bo van Santvoort Mischa Hoogeman Maarten Dirkx Floris J. Pos Tomas Janssen Andre Dekker Ben Vanneste Andre Minken Carel Hoekstra Robert J. Smeenk Inge M. van Oort Chris H. Bangma Luca Incrocci Katja K. H. Aben Katja K. H. Aben
author_sort	Marie-Christina Jahreiß
title	Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
title_short	Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
title_full	Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
title_fullStr	Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
title_full_unstemmed	Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study
title_sort	impact of advanced radiotherapy on second primary cancer risk in prostate cancer survivors: a nationwide cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e94401e37f50411fad083642701633c0
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Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study

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