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Gong S, Li G, Li D, Liu Y, Wu B. The risk for subsequent primary lung cancer after cervical carcinoma: A quantitative analysis based on 864,627 cases. PLoS One 2024; 19:e0305670. [PMID: 38913637 PMCID: PMC11195986 DOI: 10.1371/journal.pone.0305670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE To compare the risk of developing subsequent primary lung cancer among cervical cancer patients and the general population. METHODS Several databases were searched from inception to April 25, 2023. The standard incidence ratios (SIRs) with 95% confidence intervals (CIs) were combined to identify the risk for second primary lung cancer after cervical carcinoma. Subgroup analyses based on the follow-up period, age, degree of malignancy and source of SIR were conducted. All the statistical analyses were performed with STATA 15.0 software. RESULTS A total of 22 retrospective studies involving 864,627 participants were included. The pooled results demonstrated that cervical cancer patients had a significantly greater risk for lung cancer than did the general population (SIR = 2.63, 95% CI: 2.37-2.91, P<0.001). Furthermore, subgroup analyses stratified by follow-up period (<5 years and ≥5 years), age (≤50 years and <50 years), and degree of malignancy (invasive and in situ) also revealed an increased risk of developing lung cancer among cervical carcinoma patients. CONCLUSION Cervical cancer patients are more likely to develop subsequent primary lung cancer than the general population, regardless of age, follow-up time or degree of malignancy. However, more high-quality prospective studies are still needed to verify our findings.
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Affiliation(s)
- Sheng Gong
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Gang Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Dan Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Yu Liu
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Banggui Wu
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
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Kypriotakis G, Kim S, Karam-Hage M, Robinson JD, Minnix JA, Blalock JA, Cui Y, Beneventi D, Kim B, Pan IW, Shih YCT, Cinciripini PM. Examining the Association between Abstinence from Smoking and Healthcare Costs among Patients with Cancer. Cancer Prev Res (Phila) 2024; 17:217-225. [PMID: 37940143 PMCID: PMC11097145 DOI: 10.1158/1940-6207.capr-23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Center's Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden. PREVENTION RELEVANCE This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.
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Affiliation(s)
- George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seokhun Kim
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janice A Blalock
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Beneventi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - I-Wen Pan
- Department of Health Services Research The University of Texas MD Anderson Cancer Center, Houston, Texas (All work on this manuscript was conducted prior to Dr. Pan’s departure from The University of Texas MD Anderson Cancer Center.)
| | - Ya-Chen Tina Shih
- Program in Cancer Health Economics Research, UCLA Jonsson Cancer Center and School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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3
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Zhang F, Yu P, Xu L, Chen X, Du J. Differences of characteristics, influencing factors, and treatment effects on the survival in patients with first and second primary cervical cancer. Prev Med Rep 2023; 36:102504. [PMID: 38116255 PMCID: PMC10728444 DOI: 10.1016/j.pmedr.2023.102504] [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: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
To explore the characteristics, influencing factors, and effect of different treatments on the survival in patients with first primary cervical cancer (CC) and second primary CC. Data of 33,934 eligible patients with CC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in 2004-2015. We also included 176 patients with CC from the Affiliated Dongyang Hospital of Wenzhou Medical University. Univariate and multivariate Cox proportional hazard models were used to screen the potential influencing factors associated with the survival in patients with hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses of age, American Joint Committee on Cancer (AJCC) stages, tumor grades and histologic types were conducted to explore the association between different treatments and survival in different populations. The 5-year mortality was 43.08 % for patients with first primary CC and that was 58.13 % for patients with second primary CC. We found that the relationships between age, histologic type, tumor grade, tumor size, AJCC tumor-node-metastasis (TNM) stage, surgery, chemotherapy, radiotherapy and the first primary CC and second primary CC were different (all P < 0.05). Additionally, the results of subgroup analyses indicated that the choice of surgery, chemotherapy, and radiotherapy should be adjusted according to the different health conditions of the patients. In conclusion, the causal relationship between characteristics, influencing factors, and treatments and survival in patients with primary CC diagnosed as different time periods are needed further exploration.
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Affiliation(s)
- Fan Zhang
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Ping Yu
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Lixia Xu
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Xuwei Chen
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Junqiang Du
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
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Scott-Williams J, Hosein A, Akpaka P, Adidam Venkata CR. Epidemiology of Cervical Cancer in the Caribbean. Cureus 2023; 15:e48198. [PMID: 38054120 PMCID: PMC10694396 DOI: 10.7759/cureus.48198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Cervical cancer (CvC) is considered a preventable disease; however, in the Caribbean, it is still one of the fourth most common causes of death in women. Efforts to overcome obstacles to the treatment and control of this preventable disease are being made by several countries within the Caribbean. However, no health issue can be readily managed without first acquiring an understanding of the dynamics relating to its severity of impact reaching the target population, its clinical pathology, and the availability of treatment and/or preventative measures to control or halt its progression. To assess the status of CvC in the Caribbean, a review of the literature was conducted using PubMed. The Caribbean was defined in the review as comprising nations and islands whose coastlines are touched by the Caribbean Sea. This led to an assessment of the available literature on CvC for 33 Caribbean territories. The review showed a lack of published information on CvC and highlights the need for greater research. This also serves as a template for subsequent investigations.
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Affiliation(s)
- Jamie Scott-Williams
- Biomedical Engineering, The University of Trinidad and Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad and Tobago, Port of Spain, TTO
| | - Patrick Akpaka
- Pathology/Microbiology, The University of the West Indies, St. Augustine, TTO
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Xie N, Lin J, Liu L, Deng S, Yu H, Sun Y. Nomograms constructed for predicting diagnosis and prognosis in cervical cancer patients with second primary malignancies: a SEER database analysis. J Cancer Res Clin Oncol 2023; 149:13201-13210. [PMID: 37479758 DOI: 10.1007/s00432-023-05192-1] [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: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Cervical cancer (CC) patients are more likely to develop second primary malignancies (SPMs) than general population. With the advancement in cancer therapy, CC patients are achieving long-term survival, leading SPMs to our attention. Our study aims to establish diagnostic and prognostic nomograms for CC patients with second primary malignancies (CCSPMs) to help make personalized follow-up plans and treatments. METHODS Data of CCSPMs between 2000 and 2019 was extracted from SEER. The proportions and the median interval time of CCSPM onset were calculated. 11 related clinical characteristics, including age, race, marital status, grade, FIGO stage, radiotherapy, chemotherapy, and surgery, were further explore. Logistic and Cox regressions were employed to predict risk factors for CCSPMs diagnosis. Finally, two nomograms were developed to predict the probability occurrence and prognosis of CCSPMs, respectively. RESULTS For diagnostic nomogram construction, 59,178 CC patients were randomly divided into training (n = 41,426) and validation cohorts (n = 17,752). For prognostic nomogram construction, 3527 CCSPMs patients were randomly divided into training (n = 2469) and validation cohorts (n = 1058). The diagnostic nomogram consisting of above 11 independent risk factors (all P < 0.05), had high accuracy (AUCtraining = 0.851 and AUCvalidating = 0.845). The prognostic nomogram integrated with eight independent prognostic factors such as treatments, FIGO stage and TNM stage performed well in predicting 5-year OS (AUCtraining = 0.835 and AUCvalidating = 0.837). CONCLUSION Our diagnostic and prognostic nomograms could facilitate clinicians to quantify individual SPMs risk and survival probabilities and optimize the surveillance recommendations and personalized clinical decision-making.
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Affiliation(s)
- Ning Xie
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Jie Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linying Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Sufang Deng
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Haijuan Yu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Yang Sun
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China.
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Tsui J, Sloan K, Sheth R, Ewusi Boisvert E, Nieva J, Kim AW, Pang RD, Sussman S, Kirkpatrick M. Implementation planning for equitable tobacco treatment services: a mixed methods assessment of contextual facilitators and barriers in a large comprehensive cancer center. Transl Behav Med 2023; 13:539-550. [PMID: 36940412 PMCID: PMC10848232 DOI: 10.1093/tbm/ibac122] [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] [Indexed: 03/22/2023] Open
Abstract
Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population characteristics and multilevel context specific to settings serving diverse patients are needed to improve tobacco cessation among cancer patients. We examined tobacco use screening and implementation needs for tobacco treatment services to inform equitable and accessible delivery within a large comprehensive cancer center in the greater Los Angeles region. We conducted a multi-modal, mixed methods assessment using electronic medical records (EMR), and clinic stakeholder surveys and interviews (guided by the Consolidated Framework for Implementation Research). Approximately 45% of patients (n = 11,827 of 26,030 total) had missing tobacco use history in their EMR. Several demographic characteristics (gender, age, race/ethnicity, insurance) were associated with greater missing data prevalence. In surveys (n = 32), clinic stakeholders endorsed tobacco screening and cessation services, but indicated necessary improvements for screening/referral procedures. During interviews (n = 13), providers/staff reported tobacco screening was important, but level of priority differed as well as how often and who should screen. Several barriers were noted, including patients' language/cultural barriers, limited time during visits, lack of smoking cessation training, and insurance coverage. While stakeholders indicated high interest in tobacco use assessment and cessation services, EMR and interview data revealed opportunities to improve tobacco use screening across patient groups. Implementing sustainable system-level tobacco cessation programs at institutions requires leadership support, staff training, on routine screening, and intervention and referral strategies that meet patients' linguistic/cultural needs.
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Affiliation(s)
- Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rajiv Sheth
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jorge Nieva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Matthew Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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7
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Anal Cancer in High-Risk Women: The Lost Tribe. Cancers (Basel) 2022; 15:cancers15010060. [PMID: 36612055 PMCID: PMC9817901 DOI: 10.3390/cancers15010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
In developed countries the incidence of anal squamous cell carcinoma (SCC) has been rising; especially in women over the age of 60 years who present with more advanced disease stage than men. Historically, anal SCC screening has focused on people living with Human Immunodeficiency Virus (HIV) (PLWH) who are considered to be at the highest risk of anal SCC, and its precancerous lesion, anal squamous intraepithelial lesion (SIL). Despite this, women with vulval high-grade squamous epithelial lesions (HSIL) and SCCs have been shown to be as affected by anal HSIL and SCC as some PLWH. Nevertheless, there are no guidelines for the management of anal HSIL in this patient group. The ANCHOR trial demonstrated that treating anal HSIL significantly reduces the risk of anal SCC in PLWH, there is therefore an unmet requirement to clarify whether the screening and treatment of HSIL in women with a prior genital HSIL is also beneficial. This review presents the current evidence supporting the screening, treatment, and surveillance of anal HSIL in high-risk women with a previous history of genital HSIL and/or SCC.
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Song P, Wu X, Yang L, Ma K, Liu Z, Zhou J, Chen J, Zhu Q, Dong Q. Second Malignant Tumors and Non-Tumor Causes of Death for Patients With Penile Cancer During Their Survivorship. Cancer Control 2022; 29:10732748221134789. [PMID: 36267038 PMCID: PMC9597479 DOI: 10.1177/10732748221134789] [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] [Indexed: 11/26/2022] Open
Abstract
Background The aim was to evaluate the causes of death for patients with localized, regional and metastatic penile cancer (PeCa) after diagnosis. Methods PeCa patients diagnosed during 2004-2018 in the Surveillance, Epidemiology, and End Results program database were identified. Causes of deaths including PeCa, second malignant tumors (SMTs) and non-tumor diseases were analyzed, as well as the standardized mortality ratio (SMR) of each cause. Results For localized PeCa, 800 of 2155 patients died during the follow-up. 24.9% of all deaths were due to PeCa. 18.0% and 57.1% deaths were due to SMTs and non-tumor causes. Main SMTs included cancers of lung and bronchus (n = 40) and skin (n = 11) with significantly increased SMRs of 1.71 (1.22-2.33) and 4.82 (2.41-8.63). Mortality risks of other SMTs were mostly similar with the general populations. Main causes of non-tumor diseases included diseases of heart [n = 172, SMR: 1.66 (1.42-1.93)], COPD and allied cond [n = 38, SMR: 1.63 (1.15-2.24)], and cerebrovascular diseases [n = 33, SMR: 1.71 (1.17-2.4)]. For regional PeCa, 679 of 1310 patients died including 43.5% PeCa, 14.8% SMTs and 26.6% non-tumor causes. The mortality risks of cancers from lung and bronchus [SMR: 2.41 (1.53-3.62)], skin [SMR: 6.41 (2.35-13.95)] and testis [SMR: 149.35 (18.09-539.5)] were significantly increased. Main non-tumor causes of death included diseases of heart [n = 71, SMR: 1.77 (1.38-2.23)], COPD and allied cond [n = 17, SMR: 1.85 (1.08-2.95)] and diabetes mellitus [n = 16, SMR: 3.62 (2.07-5.88)]. For distant diseases, 109 of 132 patients died including 76 (69.7%) died for PeCa itself, 24 (22.0%) died for SMTs and 9 (8.3%) died for non-tumor diseases. The majority of PeCa deaths (67.1%) and SMTs deaths (79.2%) occurred within 1 year after the diagnosis of PeCa. Conclusions We firstly analyzed the SMTs and non-tumor causes of death and morality risks of each cause for PeCa patients, which provided valuable information for PeCa patients on disease prevention and health care during their survivorship.
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Affiliation(s)
- Pan Song
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China,Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Xiaotian Wu
- The Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Luchen Yang
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Ma
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhenghuan Liu
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Zhou
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Junhao Chen
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Zhu
- Department of General Medical, Medical Affairs Division, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China,Qiang Dong, Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu 610041, China.
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Barcellini A, Dominoni M, Gardella B, Mangili G, Orlandi E. Gynecological radio-induced secondary malignancy after a gynecological primary tumor: a rare entity and a challenge for oncologists. Int J Gynecol Cancer 2022; 32:1321-1326. [PMID: 36515563 DOI: 10.1136/ijgc-2022-003686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The management of radiation-induced secondary malignancies in the female genital tract after pelvic radiation treatment for a primary gynecological tumor is a challenge for multidisciplinary teams that follow survivors. Considering the lack of data on the incidence of this disease and the absence of guidelines for its management, in this review, the available literature is analyzed to determine the characteristics and the clinical management of gynecological radiation-induced secondary malignancies. Gynecological radiation-induced secondary malignancies were found to be predominantly more aggressive, poorly differentiated, and had rare histologic types compared with sporadic tumors. The management is influenced by previous radiation doses and the localization of the radiation-induced secondary malignancies. Surgery, when feasible, was the cornerstone; re-irradiation was an option when a surgical approach was not feasible and high-dose conformal techniques should be preferred considering the need to spare previously irradiated surrounding normal tissues. Clinical outcomes, when reported, were poor in terms of local control and survival. Given the difficulty in managing these uncommon malignancies, a centralization of care in sites that are connected to research networks actively partaking in international discussions and with higher expertise in complicated surgery or radiotherapy should be considered to improve clinical outcomes.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giorgia Mangili
- Obstetrics & Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ester Orlandi
- Radiation Oncology, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Xu J, Huang C, Wu Z, Xu H, Li J, Chen Y, Wang C, Zhu J, Qin G, Zheng X, Yu Y. Risk Prediction of Second Primary Malignancies in Primary Early-Stage Ovarian Cancer Survivors: A SEER-Based National Population-Based Cohort Study. Front Oncol 2022; 12:875489. [PMID: 35664751 PMCID: PMC9161780 DOI: 10.3389/fonc.2022.875489] [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: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to characterize the clinical features of early-stage ovarian cancer (OC) survivors with second primary malignancies (SPMs) and provided a prediction tool for individualized risk of developing SPMs. Methods Data were obtained from the Surveillance, Epidemiology and End Results (SEER) database during 1998-2013. Considering non-SPM death as a competing event, the Fine and Gray model and the corresponding nomogram were used to identify the risk factors for SPMs and predict the SPM probabilities after the initial OC diagnosis. The decision curve analysis (DCA) was performed to evaluate the clinical utility of our proposed model. Results A total of 14,314 qualified patients were enrolled. The diagnosis rate and the cumulative incidence of SPMs were 7.9% and 13.6% [95% confidence interval (CI) = 13.5% to 13.6%], respectively, during the median follow-up of 8.6 years. The multivariable competing risk analysis suggested that older age at initial cancer diagnosis, white race, epithelial histologic subtypes of OC (serous, endometrioid, mucinous, and Brenner tumor), number of lymph nodes examined (<12), and radiotherapy were significantly associated with an elevated SPM risk. The DCA revealed that the net benefit obtained by our proposed model was higher than the all-screening or no-screening scenarios within a wide range of risk thresholds (1% to 23%). Conclusion The competing risk nomogram can be potentially helpful for assisting physicians in identifying patients with different risks of SPMs and scheduling risk-adapted clinical management. More comprehensive data on treatment regimens and patient characteristics may help improve the predictability of the risk model for SPMs.
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Affiliation(s)
- Jiaqin Xu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ce Wang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
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11
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Muacevic A, Adler JR, Andine TF, Elleissy Nasef K, Akinwumi B, Oduwole A, Lipscombe C, Ojo AS, Fakorede M. Second Malignancies Following Primary Cervical Cancer Diagnosis: Analysis of the SEER Database. Cureus 2022; 14:e26171. [PMID: 35891874 PMCID: PMC9306408 DOI: 10.7759/cureus.26171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction While mortality following primary cervical cancers (PCCs) continues to decline due to advancements in screening and treatment, a small subset of women who developed PCCs will develop second malignancies after their initial diagnosis. Little is known about these women. Objective This study aims to determine the common second malignancies among patients with primary cervical cancers and the factors associated with improved overall survival. Methodology We conducted a retrospective analysis of all PCCs in the SEER database between 1975 and 2016. We identified a subset of patients who subsequently developed secondary malignancies after a primary cervical cancer diagnosis. We then determined the factors associated with a prolonged latency interval, defined as the time between the PCC diagnosis and a subsequent secondary malignancy diagnosis. In a sub-analysis, we also determined the commonest secondary malignancies following a PCC diagnosis. Results A total of 1,494 patients with cervical cancers developed a second malignancy during the study period. The mean age at diagnosis of the PCCs was 56.0 ± 14.0 years. The mean latency interval between PCC and a subsequent secondary malignancy was 9.6 ± 9.3 years. Cytoreductive surgery (odds ratio (OR) = 1.40; 95% confidence interval (CI) = 1.05-1.86) and radiotherapy (OR = 1.52; 95% CI = 1.14-2.03) during the PCC are associated with a prolonged latency interval. Patients who received chemotherapy (OR = 0.23; 95% CI = 0.16-0.33) or those of Hispanic ethnicity (OR = 0.63; 95% CI = 0.44-0.90) were more likely to develop second malignancies within 10 years after a PCC diagnosis. The most common second malignancies were abdominal malignancies with rectal cancers (12.2%), pancreatic cancers (10.1%), stomach cancers (9.2%), cecum cancers (8.4%), and sigmoid colon cancers (8.3%). Conclusion There is a significant association between Hispanic ethnicity and a shorter latency interval among patients with PCC. The findings from this study may help optimize screening for secondary cancers among cervical cancer survivors.
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12
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Huang K, Xu L, Jia M, Liu W, Wang S, Han J, Li Y, Song Q, Fu Z. Second primary malignancies in cervical cancer and endometrial cancer survivors: a population-based analysis. Aging (Albany NY) 2022; 14:3836-3855. [PMID: 35507749 PMCID: PMC9134942 DOI: 10.18632/aging.204047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 01/24/2023]
Abstract
Background: We evaluated the relative attribution and interactions of treatment and patient-related risk factors for second primary malignancies (SPMs) in cervical and endometrial cancer survivors. Methods: Stage I–III cervical and endometrial cancer survivors’ data from the Surveillance, Epidemiology, and End Results (SEER) registry between January 1988 and December 2015 were analyzed. The standardized incidence ratio (SIR), excess absolute risk (EAR), and corresponding 95% confidence interval (95% CI) values were calculated. Analyses were classified based on proxies of human papillomavirus (HPV), smoking, hormone, and radiotherapy (RT) status. Additive and multiplicative interactions were assessed. Results: Cervical cancer survivors had a higher risk for developing potentially HPV and smoking-related SPMs, especially in the RT group (SIRHPV = 3.7, 95% CI: 2.9–4.6; SIRsmoking = 3.2, 95% CI: 2.8–3.6). Second vaginal cancer patients had the highest SIR (23.8, 95% CI: 14.9–36.0). There were strong synergistic interactions between RT and the proxy of smoking (Pinteraction < 0.001), accounting for 36% of potentially smoking-related SPMs in cervical cancer survivors. Conclusions: RT, HPV, and smoking promote SPMs in cervical cancer to different extents. The SPM burden in cervical cancer survivors could be mostly attributed to smoking and RT and their interactions.
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Affiliation(s)
- Kejie Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lijuan Xu
- Department of Health Management, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Mingfang Jia
- Department of Health Management, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Wenmin Liu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Shijie Wang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jianglong Han
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yanbo Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
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13
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GCIG-Consensus guideline for Long-term survivorship in gynecologic Cancer: A position paper from the gynecologic cancer Intergroup (GCIG) symptom benefit committee. Cancer Treat Rev 2022; 107:102396. [PMID: 35525106 DOI: 10.1016/j.ctrv.2022.102396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-term survivors of gynecological cancers may be cured but still have ongoing health concerns and long-term side effects following cancer treatment. The aim of this brainstorming meeting was to develop recommendations for long-term follow-up for survivors from gynecologic cancer. METHODS International experts, representing each member group within the Gynecologic Cancer InterGroup (GCIG), met to define long-term survival, propose guidelines for long term follow-up and propose ways to implement long term survivorship follow-up in clinical trials involving gynecological cancers. RESULTS Long-term survival with/from gynecological cancers was defined as survival of at least five years from diagnosis, irrespective of disease recurrences. Review of the literature showed that more than 50% of cancer survivors with gynecological cancer still experienced health concerns/long-term side effects. Main side effects included neurologic symptoms, sleep disturbance, fatigue, sexual dysfunction, bowel and urinary problems and lymphedema. In this article, long-term side effects are discussed in detail and treatment options are proposed. Screening for second primary cancers and lifestyle counselling (nutrition, physical activity, mental health) may improve quality of life and overall health status, as well as prevent cardiovascular events. Clinical trials should address cancer survivorship and report patient reported outcome measures (PROMs) for cancer survivors. CONCLUSION Long-term survivors after gynecological cancer have unique longer term challenges that need to be addressed systematically by care givers. Follow-up after completing treatment for primary gynecological cancer should be offered lifelong. Survivorship care plans may help to summarize cancer history, long-term side effects and to give information on health promotion and prevention.
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14
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Nitta Y, Murata H, Okonogi N, Murata K, Wakatsuki M, Karasawa K, Kato S, Yamada S, Nakano T, Tsuji H. Secondary cancers after carbon-ion radiotherapy and photon beam radiotherapy for uterine cervical cancer: A comparative study. Cancer Med 2022; 11:2445-2454. [PMID: 35318825 PMCID: PMC9189463 DOI: 10.1002/cam4.4622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There are limited studies on the risk of secondary cancers after carbon-ion radiotherapy (CIRT). We assessed the incidence of secondary cancers in patients treated with CIRT for cervical cancer. We also evaluated the incidence of secondary cancers in patients who received standard photon radiotherapy (RT) throughout the same period. METHODS This retrospective study included patients with cervical cancer who underwent curative RT at our hospital. All cancers discovered for the first time after RT were classified as secondary cancers. To compare the risk of secondary cancers among cervical cancer survivors to the general population, standardized incidence ratios (SIRs) were calculated. RESULTS The analysis included a total of 197 and 417 patients in the CIRT and photon RT groups, respectively. The total person-years during the observation period were 1052.4 in the CIRT group and 2481.5 in the photon RT group. The SIR for all secondary cancers was 1.1 (95% confidence interval [CI], 0.6-2.1) in the CIRT group and 1.4 (95% CI, 1.0-2.1) in the photon RT group. The 10-year cumulative incidence of all secondary cancers was 9.5% (95% CI, 4.0-21.5) in the CIRT group and 9.4% (95% CI, 6.2-14.1) in the photon RT group. The CIRT and photon RT groups were not significantly different in incidence (p = 0.268). CONCLUSIONS The incidence of secondary cancers after CIRT for cervical cancer was similar to that after photon RT. Validation of our findings after long-term observation is warranted.
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Affiliation(s)
- Yuki Nitta
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroto Murata
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takashi Nakano
- Quantum Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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15
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Porchia BFMM, Aps LRDMM, Moreno ACR, da Silva JR, Silva MDO, Sales NS, Alves RPDS, Rocha CRR, Silva MM, Rodrigues KB, Barros TB, Pagni RL, Souza PDC, Diniz MDO, Ferreira LCDS. Active immunization combined with cisplatin confers enhanced therapeutic protection and prevents relapses of HPV-induced tumors at different anatomical sites. Int J Biol Sci 2022; 18:15-29. [PMID: 34975315 PMCID: PMC8692155 DOI: 10.7150/ijbs.56644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
The active immunotherapy concept relies on the use of vaccines that are capable of inducing antitumor immunity, reversion of the suppressive immunological environment, and long-term memory responses. Previously, antitumor vaccines based on a recombinant plasmid (pgDE7h) or a purified protein (gDE7) led to regression of early-established human papillomavirus (HPV)-associated tumors in a preclinical model. In this work, the anticancer vaccines were combined with cisplatin to treat HPV-induced tumors at advanced growth stages. The antitumor effects were evaluated in terms of tumor regression, induction of specific CD8+ T cells, and immune modulation of the tumor microenvironment. Acute toxicity induced by the treatment was measured by weight loss and histological alterations in the liver and kidneys. Our results revealed that the combination of cisplatin with either one of the tested immunotherapies (pgDE7h or gDE7) led to complete tumor regression in mice. Also, the combined treatment resulted in synergistic effects, particularly among mice immunized with gDE7, including activation of systemic and tumor-infiltrating E7-specific CD8+ T cells, tumor infiltration of macrophages and dendritic cells, and prevention of tumor relapses at different anatomical sites. Furthermore, the protocol allowed the reduction of cisplatin dosage and its intrinsic toxic effects, without reducing antitumor outcomes. These results expand our knowledge of active immunotherapy protocols and open perspectives for alternative treatments of HPV-associated tumors.
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Affiliation(s)
- Bruna Felício Milazzotto Maldonado Porchia
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.,ImunoTera Soluções Terapêuticas Ltda
| | - Luana Raposo de Melo Moraes Aps
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.,ImunoTera Soluções Terapêuticas Ltda
| | - Ana Carolina Ramos Moreno
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Jamile Ramos da Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariângela de Oliveira Silva
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Natiely Silva Sales
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Rubens Prince Dos Santos Alves
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Clarissa Ribeiro Reily Rocha
- DNA Repair Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Molina Silva
- DNA Repair Laboratory, Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Karine Bitencourt Rodrigues
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Tácita Borges Barros
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberta Liberato Pagni
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Patrícia da Cruz Souza
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariana de Oliveira Diniz
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.,ImunoTera Soluções Terapêuticas Ltda
| | - Luís Carlos de Souza Ferreira
- Vaccine Development Laboratory, Department of Microbiology, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
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16
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Jahreiß MC, Heemsbergen WD, van Santvoort B, Hoogeman M, Dirkx M, Pos FJ, Janssen T, Dekker A, Vanneste B, Minken A, Hoekstra C, Smeenk RJ, van Oort IM, Bangma CH, Incrocci L, Aben KKH. Impact of Advanced Radiotherapy on Second Primary Cancer Risk in Prostate Cancer Survivors: A Nationwide Cohort Study. Front Oncol 2021; 11:771956. [PMID: 34900722 PMCID: PMC8662556 DOI: 10.3389/fonc.2021.771956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose External 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 Methods PCa 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. Results PCa 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). Conclusion SPC 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.
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Affiliation(s)
| | - Wilma D Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Bo van Santvoort
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - Mischa Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Maarten Dirkx
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Floris J Pos
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, Netherlands
| | - Tomas Janssen
- The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW Institute for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Ben Vanneste
- Department of Radiation Oncology (Maastro), GROW Institute for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Andre Minken
- Department of Radiation Oncology, Radiotherapiegroep, Deventer, Netherlands
| | - Carel Hoekstra
- Department of Radiation Oncology, Radiotherapiegroep, Deventer, Netherlands
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Luca Incrocci
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Katja K H Aben
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.,Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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17
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Wu Y, Chong Y, Han C, Kang K, Liu Z, Zhang F. Second primary malignancies associated with radiation therapy in cervical cancer patients diagnosed between 1975 and 2011: a population-based competing-risk study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1375. [PMID: 34733927 PMCID: PMC8506544 DOI: 10.21037/atm-21-1393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 01/09/2023]
Abstract
Background Cervical cancer is a major health threat for women. Radiotherapy plays an important role in the treatment of cervical cancer. However, its overall benefit has been questioned due to the risk of second primary malignancies. Methods The Surveillance, Epidemiology, and End Results (SEER) database was used to search for cervical cancer patients diagnosed between January 1975 and November 2011. Factors that could possibly affect the occurrence of second primary malignancies included the year of diagnosis, gender, ethnicity, histologic type, SEER cancer stage, histology, grade, and whether surgery, chemotherapy, or radiotherapy were used. Age-adjusted and propensity scoring matching (PSM)-adjusted competing-risk analysis was applied for analysis. Results Of the 23,112 patients identified through SEER, 14,800 (64.0%) received radiotherapy. Second malignancies were diagnosed in 2,545 (11.0%) cases. PSM-adjusted competing analysis revealed that patients receiving radiotherapy had a significantly higher risk of developing a second cancer in the colon, rectum and anus [hazard ratio (HR): 1.43; 95% confidence interval (CI): 1.09-1.87; P=0.01], lung and bronchus (HR: 1.41; 95% CI: 1.13-1.76; P=0.002), corpus uteri (HR: 3.71; 95% CI: 1.71-8.06; P<0.001), ovary (HR: 2.79; 95% CI: 1.38-5.64; P=0.004), and urinary bladder (HR: 2.18; 95% CI: 1.35-3.54; P=0.002). However, radiotherapy significantly lowered the risk of second cancers in the female breast (HR: 0.67; 95% CI: 0.52-0.86; P=0.002). Age-adjusted competing-risk analysis showed generally consistent results. Conclusions Radiotherapy increased the risk of second cancers among cervical cancer patients. Those who underwent radiotherapy had a significantly higher risk of developing a second cancer in the colon, rectum and anus, lung and bronchus, corpus uteri, ovary, and urinary bladder.
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Affiliation(s)
- Yijun Wu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuming Chong
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Chang Han
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Kai Kang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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18
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Węgierek-Ciuk A, Lankoff A, Lisowska H, Kędzierawski P, Akuwudike P, Lundholm L, Wojcik A. Cisplatin Reduces the Frequencies of Radiotherapy-Induced Micronuclei in Peripheral Blood Lymphocytes of Patients with Gynaecological Cancer: Possible Implications for the Risk of Second Malignant Neoplasms. Cells 2021; 10:2709. [PMID: 34685687 PMCID: PMC8534481 DOI: 10.3390/cells10102709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 01/22/2023] Open
Abstract
Gynaecologic cancers are common among women and treatment includes surgery, radiotherapy or chemotherapy, where the last two methods induce DNA damage in non-targeted cells like peripheral blood lymphocytes (PBL). Damaged normal cells can transform leading to second malignant neoplasms (SMN) but the level of risk and impact of risk modifiers is not well defined. We investigated how radiotherapy alone or in combination with chemotherapy induce DNA damage in PBL of cervix and endometrial cancer patients during therapy. Blood samples were collected from nine endometrial cancer patients (treatment with radiotherapy + chemotherapy-RC) and nine cervical cancer patients (treatment with radiotherapy alone-R) before radiotherapy, 3 weeks after onset of radiotherapy and at the end of radiotherapy. Half of each blood sample was irradiated ex vivo with 2 Gy of gamma radiation in order to check how therapy influenced the sensitivity of PBL to radiation. Analysed endpoints were micronucleus (MN) frequencies, apoptosis frequencies and cell proliferation index. The results were characterised by strong individual variation, especially the MN frequencies and proliferation index. On average, despite higher total dose and larger fields, therapy alone induced the same level of MN in PBL of RC patients as compared to R. This result was accompanied by a higher level of apoptosis and stronger inhibition of cell proliferation in RC patients. The ex vivo dose induced fewer MN, more apoptosis and more strongly inhibited proliferation of PBL of RC as compared to R patients. These results are interpreted as evidence for a sensitizing effect of chemotherapy on radiation cytotoxicity. The possible implications for the risk of second malignant neoplasms are discussed.
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Affiliation(s)
- Aneta Węgierek-Ciuk
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
| | - Anna Lankoff
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
- Centre for Radiobiology and Biological Dosimetry, Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw, Poland
| | - Halina Lisowska
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
| | - Piotr Kędzierawski
- Department of Radiotherapy, Holy Cross Cancer Center, Artwinskiego 3, 25-734 Kielce, Poland;
| | - Pamela Akuwudike
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
| | - Lovisa Lundholm
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
| | - Andrzej Wojcik
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
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19
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Yang YR, Chen SJ, Yen PY, Huang CP, Chiu LT, Lin WC, Chen HY, Chen YH, Chen WC. Hydronephrosis in patients with cervical cancer is an indicator of poor outcome: A nationwide population-based retrospective cohort study. Medicine (Baltimore) 2021; 100:e24182. [PMID: 33578522 PMCID: PMC7886411 DOI: 10.1097/md.0000000000024182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
Cervical cancer is a common malignancy in women. The presence of hydronephrosis in patients with cervical cancer can be a challenging clinical problem. The appropriate management of these patients and the prediction of their outcomes are concerns among gynecologists, urologists, medical oncologists, radiation oncologists, and nephrologists. We enrolled a total of 2225 patients with cervical cancer over a 12-year period from the nationwide database of Taiwan's National Health Insurance Bureau. Among them, 445 patients had concomitant hydronephrosis. The remaining 1780 patients without hydronephrosis were randomly enrolled as a control group for the analysis of associated factors. The results indicated that the proportions of patients with hypertension, chronic kidney disease, and diabetes were significantly higher in the hydronephrosis group. The hydronephrosis group showed a higher all-cause mortality than the non-hydronephrosis group (adjusted hazard ratio 3.05, 95% confidence interval 2.24-4.15, P < .001). The rates of nephrectomy and stone disease were also significantly higher in the hydronephrosis group. A higher percentage of other cancers was also observed in the hydronephrosis group than in the non-hydronephrosis group (12.36% vs 8.99%, respectively). This study shows that cervical cancer with hydronephrosis may have a higher morbidity and mortality than cervical cancer without hydronephrosis. Other factors such as human papilloma virus vaccination, smoking, and cancer staging need to be further studied.
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Affiliation(s)
- You-Rong Yang
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital
| | - Pin-Yeh Yen
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Chi-Ping Huang
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Lu-Ting Chiu
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Wu-Chou Lin
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Huey-Yi Chen
- Department of Urology, Department of Obstetrics & Gynecology, Management Office for Health Data, China Medical University Hospital
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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20
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Agrawal A, Huang KG, Lai SY. Laparoscopic Staging of Uterine Carcinosarcoma Following Radiotherapy for Cervical Cancer. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ajay Agrawal
- Department of Obstetrics and Gynecology, BPKIHS, Dharan, Nepal
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Yen Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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21
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Li R, Zhang Y, Ma B, Tan K, Lynn HS, Wu Z. Survival analysis of second primary malignancies after cervical cancer using a competing risk model: implications for prevention and surveillance. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:239. [PMID: 33708866 PMCID: PMC7940922 DOI: 10.21037/atm-20-2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Previous studies have reported an increased risk for second primary malignancies (SPMs) after cervical cancer (CC). This study aims to quantify and assess the risk of developing SPMs in long-term survivors of CC. Methods A population-based cohort of CC patients aged 20–79 years was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk model and corresponding nomogram were constructed to predict the 3-, 5-, and 10-year cumulative risks of SPMs. A Fine-Gray plot was created to validate the model. Finally, we performed decision curve analysis (DCA) to evaluate the clinical usefulness of the model by calculating the net benefit. Results A total of 34,295 patients were identified, and approximately 6.3% of the study participants developed SPMs. According to the multivariable competing-risk model, older black CC survivors with localized disease who were treated with radiation therapy were more susceptible to SPMs. The 3-, 5-, and 10-year cumulative incidences of SPMs were 2.5%, 3.6%, and 6.2%, respectively. Calibration curves showed good agreement between the predicted and observed models. The DCA yielded a wide range of risk thresholds at which the net benefits could be obtained from our proposed model. Conclusions This study provides physicians with a practical, individualized prognostic estimate to assess the risk of SPMs among CC survivors. CC survivors remain at a high risk of developing SPMs, and further surveillance should focus especially on the patients with black race, older age, localized disease, or those having received radiation therapy.
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Affiliation(s)
- Runmei Li
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Bingqing Ma
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Kangming Tan
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Henry S Lynn
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
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22
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Mahalingam S, Sundaramurthi S, Krishnaraj B, Sistla SC. Radiation-induced sarcoma presenting as a gluteal abscess: a diagnostic and therapeutic challenge. BMJ Case Rep 2020; 13:13/12/e236601. [PMID: 33318271 PMCID: PMC7737037 DOI: 10.1136/bcr-2020-236601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.
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Affiliation(s)
- Sudharshan Mahalingam
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Sudharsanan Sundaramurthi
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | | | - Sarath Chandra Sistla
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
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23
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Jahreiß MC, Aben KKH, Hoogeman MS, Dirkx MLP, de Vries KC, Incrocci L, Heemsbergen WD. The Risk of Second Primary Cancers in Prostate Cancer Survivors Treated in the Modern Radiotherapy Era. Front Oncol 2020; 10:605119. [PMID: 33282746 PMCID: PMC7691574 DOI: 10.3389/fonc.2020.605119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Concerns have been raised that modern intensity modulated radiotherapy (IMRT) may be associated with increased second primary cancer risks (SPC) compared to previous three-dimensional conformal radiation techniques (3DCRT), due to increased low dose volumes and more out-of-field ionizing dose to peripheral tissue further away from the target. We assessed the impact of treatment technique on SPC risks in a cohort of prostate cancer (PCa) survivors. Material and Methods The study cohort comprised 1,561 PCa survivors aged 50–79 years at time of radiotherapy, treated between 2006–2013 (N=707 IMRT, N=854 3DCRT). Treatment details were extracted from radiotherapy systems and merged with longitudinal data of the Netherlands Cancer Registry to identify SPCs. Primary endpoint was the development of a solid SPC (excluding skin cancer) in peripheral anatomical regions, i.e. non-pelvic. Applied latency period was 12 months. SPC rates in the IMRT cohort (total cohort and age subgroups) were compared to 1) the 3DCRT cohort by calculating Sub-Hazard Ratios (sHR) using a competing risk model, and 2) to the general male population by calculating Standardized Incidence Ratios (SIR). Models were adjusted for calendar period and age. Results Median follow-up was 8.0 years (accumulated 11,664 person-years at-risk) with 159 cases developing ≥1 non-pelvic SPC. For IMRT vs 3DCRT we observed a significantly (p=0.03) increased risk (sHR=1.56, 95% Confidence Interval (CI) 1.03–2.36, corresponding estimated excess absolute risk (EAR) of +7 cases per 10,000 person-years). At explorative analysis, IMRT was in particular associated with increased risks within the subgroup of active smokers (sHR 2.94, p=0.01). Within the age subgroups 50–69 and 70–79 years, the sHR for non-pelvic SPC was 3.27 (p=0.001) and 0.96 (p=0.9), respectively. For pelvic SPC no increase was observed (sHR=0.8, p=0.4). Compared to the general population, IMRT was associated with significantly increased risks for non-pelvic SPC in the 50–69 year age group (SIR=1.90, p<0.05) but not in the 70–79 years group (SIR=1.08). Conclusion IMRT is associated with increased SPC risks for subjects who are relatively young at time of treatment. Additional research on aspects of IMRT that may cause this effect is essential to minimize risks for future patients receiving modern radiotherapy.
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Affiliation(s)
| | - Katja K H Aben
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.,Research Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Mischa S Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Maarten L P Dirkx
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Kim C de Vries
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Luca Incrocci
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Wilma D Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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24
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Risk of second primary cancers among survivors of gynecological cancers. Gynecol Oncol 2020; 158:719-726. [PMID: 32616403 DOI: 10.1016/j.ygyno.2020.06.492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Survivors of gynecologic cancers have an increased risk of developing second primary cancers (SPC); however it is unclear which sites have higher risks. We aimed to ascertain risk of SPC among survivors of gynecological cancer, and identify anatomic sites at risk of SPC. METHODS We queried the Surveillance, Epidemiology and End Results database (2000-2016) for confirmed cases of index gynecological (cervix uteri [cervical], corpus and uterus [endometrial], ovarian, vaginal, and vulvar) cancers. Risk of SPC was estimated using standardized incidence ratios (SIRs: observed/expected cases) and excess absolute risks (EARs: observed - expected cases) per 10,000 person-years at risk (PYR). SIRs and EARs were stratified by index anatomic site and latency interval. RESULTS Among the cohort of 301,210 gynecological cancer survivors, 19,005 (6.31%) developed an SPC (SIR = 1.16; 95% CI, 1.15-1.18 and EAR = 17.2 cases per 10,000 PYR) compared with the general population. All gynecological cancer survivors (except survivors of ovarian) had a significant risk of developing SPC (SIR range 1.06-2.16), with survivors of vulvar cancer having the highest risk (SIR = 2.16; 95% CI, 2.06-2.27; EAR = 139.5 per 10,000 PYR). Risk of SPC was highest within the first 5 years post-diagnosis for survivors of cervical, vulvar and vaginal cancers. CONCLUSIONS While most index gynecological cancer sites are associated with increased risk of SPC, risk is highest among survivors of vulvar cancer. These findings have the potential to inform lifelong surveillance recommendations for gynecological cancer survivors.
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25
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Puleo GE, Borger TN, Montgomery D, Rivera JNR, Burris JL. A Qualitative Study of Smoking-Related Causal Attributions and Risk Perceptions in Cervical Cancer Survivors. Psychooncology 2020; 29:500-506. [PMID: 31733086 PMCID: PMC7054153 DOI: 10.1002/pon.5291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The prevalence of smoking among cervical cancer survivors typically exceeds what is found among women in the general population and other cancer survivors. Yet, there is a dearth of literature on risk and protective factors related to smoking among cervical cancer survivors, especially when it comes to identification of variables that are amendable to intervention. To help fill this gap in the literature, this qualitative study examines the nature of smoking-related causal attributions and risk perceptions in cervical cancer survivors who smoked at cancer diagnosis. METHODS Participants are 21 female cervical cancer survivors (M=45.7, SD=8.4 years old), all diagnosed in the past five years. Nearly three-quarters of participants reported smoking in the past month. RESULTS Smoking was not uniformly recognized as a cause of cervical cancer (whether in general or participants' own cancer); the link between smoking and lung, head-neck, and other cancers was more readily accepted. Despite generally weak endorsements of causal attributions, many participants reported smoking significantly increases risk for poor clinical (e.g., recurrence) and quality of life (e.g., pain) outcomes after cervical cancer diagnosis. CONCLUSIONS Findings suggest cervical cancer survivors may not fully understand or appreciate the role of smoking in cervical cancer risk whereas their beliefs about the role of smoking in cervical cancer prognosis are more well-formed. This study highlights the potential role of causal attributions and risk perceptions in understanding and addressing the smoking-related experience of cervical cancer survivors.
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Affiliation(s)
| | - Tia N. Borger
- Department of Psychology, University of Kentucky, Lexington KY, USA
| | | | | | - Jessica L. Burris
- Department of Psychology, University of Kentucky, Lexington KY, USA
- Markey Cancer Center, University of Kentucky, Lexington KY, USA
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26
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Makhmudov DE, Kolesnik OO, Lagoda NN, Volk MO. Leiomyosarcoma of the Rectum as a Radiation-Induced Second Malignancy after Cervical Cancer Treatment: Case Report with Review of the Literature. Case Rep Oncol Med 2019; 2019:1610653. [PMID: 31885968 PMCID: PMC6925813 DOI: 10.1155/2019/1610653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Incidence of cervical cancer among women of reproductive age still remains significantly high. In regard to prognostic features and risk factors, the standard treatment for most types of cervical cancer represents a combination of surgical treatment and radiation therapy, such as external beam radiation therapy and brachytherapy. Despite significant advances of long-term oncological outcomes, radiation-induced secondary malignancies among cervical cancer survivors are still an issue. Current case report describes an incredibly rare case of radiation-induced leiomyosarcoma of the rectum, which occurred 32 years after cervical cancer treatment. CASE PRESENTATION A 62-year-old female had a past medical history of FIGO stage IIB cervical cancer (squamous cell carcinoma pT2bN0M0). In 1987, she underwent radical hysterectomy with bilateral iliac lymph node dissection, followed by adjuvant radiation therapy-70 Gy external beam pelvic irradiation followed by 30.5 Gy of brachytherapy. Thirty-two years later, she presented with signs of rectal bleeding. Regarding past medical history, radiologic, endoscopic, and pathologic data, the patient was initially diagnosed with a malignant nonepithelial lower rectal tumor of the unknown origin and staged as mrT3a mrN0 cM0. Total mesorectal excision with complete mesocolic excision and central vascular ligation (CME/CVL) carried by an open approach was carried out. In an attempt to identify the tissue of origin, an immunohistochemistry assay had been performed. Tumor cells showed a high rate of mitotic activity with a 45% rate of Ki-67 expression, positive reaction for desmin, and SMA in all samples. Negative reaction for CD117 and S100 was observed. As a conclusion, the immunophenotype was identified as a grade 3 leiomyosarcoma (ISD-code 8890/3). CONCLUSIONS We suggest that up to date, radical surgery with curative intent, as it was performed in our study, is the most evidence-based treatment option for patients with radiation-induced sarcomas of the rectum.
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Affiliation(s)
- Dmytro E. Makhmudov
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Olena O. Kolesnik
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Natalia N. Lagoda
- Department of Pathomorphology, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Maryna O. Volk
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
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27
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Zhang L, Hemminki O, Chen T, Zheng G, Försti A, Sundquist K, Sundquist J, Hemminki K. Familial Clustering, Second Primary Cancers and Causes of Death in Penile, Vulvar and Vaginal Cancers. Sci Rep 2019; 9:11804. [PMID: 31413311 PMCID: PMC6694134 DOI: 10.1038/s41598-019-48399-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/02/2019] [Indexed: 12/19/2022] Open
Abstract
Data on familial risks in penile and vulvar/vaginal cancers and in second primary cancers (SPCs) following these cancers are limited. We used the Swedish Family-Cancer Database from years 1958 through 2015 to identify 3641 penile and 8856 vulvar/vaginal cancers and to calculate relative risks (RRs) and 95% confidence intervals (CIs) for these cancers according to site-specific cancer in family members; additionally risk for SPCs was calculated. The familial RR for concordant (same) penile cancer was 3.22 (1.34-7.74), and it was 2.72 (1.69-4.39) for vulvar/vaginal cancer; RRs were increased for vulvar/vaginal cancer in families of anal cancer patients. RR for second penile cancer after penile cancers was 11.68 (7.95-17.18), while that for concordant vulvar/vaginal cancer was 9.03 (7.31-11.15). SPCs were diagnosed in 16.8% of penile cancer patients and in them 45.9% of deaths were caused by SPC (other than penile cancer). In vulvar/vaginal cancer patients with SPC, 36.4% of deaths were due to SPC. The results showed that these genital cancers might run in families and as SPCs are associated with human papilloma virus and smoking related cancers. Risk for these genital and anal SPCs are high and a follow-up plan should be agreed at diagnosis of these cancers.
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Affiliation(s)
- Luyao Zhang
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Otto Hemminki
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tianhui Chen
- Group of Molecular Epidemiology and Cancer Precision Prevention, Zhejiang Academy of Medical Sciences (ZJAMS), Hangzhou, China
| | - Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
- Group of Molecular Epidemiology and Cancer Precision Prevention, Zhejiang Academy of Medical Sciences (ZJAMS), Hangzhou, China.
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28
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Gilbert DC, Wakeham K, Langley RE, Vale CL. Increased risk of second cancers at sites associated with HPV after a prior HPV-associated malignancy, a systematic review and meta-analysis. Br J Cancer 2018; 120:256-268. [PMID: 30482913 PMCID: PMC6342987 DOI: 10.1038/s41416-018-0273-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/20/2018] [Accepted: 09/04/2018] [Indexed: 01/17/2023] Open
Abstract
Background High-risk human papilloma viruses (HPV) are a causative agent of anogenital and oropharyngeal cancers. Patients treated for a preinvasive or invasive HPV-associated cancer may be at increased risk of a second such malignancy. Methods We performed a systematic review and random effects meta-analysis to estimate the risk of HPV-associated cancer after prior diagnosis. Studies reporting second cancers at anogenital and oropharyngeal sites after prior diagnoses (preinvasive/invasive HPV-associated cancer) were identified. Studies reporting standardised incidence ratios (SIRs) were included in formal meta-analyses of second cancer risk. (PROSPERO ID: CRD42016046974). Results Searches returned 5599 titles, including 60 unique, eligible studies. Thirty-two (98 comparisons) presented SIRs for second cervical, anal, vulvo-vaginal, penile, and/or oropharyngeal cancers, included in the meta-analyses. All studies (and 95/98 comparisons) reported increased cancers in the population with previous HPV-associated cancer when compared to controls. Pooled SIRs for second primary cancers ranged from 1.75 (95% CI 0.66−4.67) for cervical cancer after primary anal cancer, to 13.69 (95% CI 8.56−21.89) for anal cancer after primary vulvo-vaginal cancer. Conclusions We have quantified the increased risk of second HPV-associated cancer following diagnosis and treatment for initial cancer or preinvasive disease. This has important implications for follow-up, screening, and future therapeutic trials.
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Affiliation(s)
- Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK. .,Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, UK.
| | - Katie Wakeham
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK
| | - Claire L Vale
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK
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Ma L, Yu Y, Qu X. Suppressing serum response factor inhibits invasion in cervical cancer cell lines via regulating Egr‑1 and epithelial-mesenchymal transition. Int J Mol Med 2018; 43:614-620. [PMID: 30365040 DOI: 10.3892/ijmm.2018.3954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022] Open
Abstract
Serum response factor (SRF) is a transcription factor that has important roles in tumor progression. However, its role in cervical cancer cell proliferation and invasion remains unclear. The present study revealed that SRF silencing constrained cervical cancer cell proliferation and invasion via controlling early growth response‑1 (Egr‑1). The results demonstrated that SRF was significantly increased in cervical cancer tissues and cell lines, compared with normal. Suppressing SRF, by using a loss‑of‑function experiment, constrained cervical cancer cell proliferation, invasion, and epithelial‑mesenchymal transition. Furthermore, SRF knockdown significantly downregulated Egr‑1 expression in cervical cancer cell lines, and overexpression of Egr‑1 reversed the effect of SRF on cell proliferation, invasion, and epithelial‑mesenchymal transition. Therefore, SRF may control cell proliferation and invasion by regulating Egr‑1 in cervical cancer.
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Affiliation(s)
- Liya Ma
- Clinical Skills Training Center, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, P.R. China
| | - Ying Yu
- Perinatal Care Division, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, P.R. China
| | - Xiaohui Qu
- Obstetrics and Gynecology, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712000, P.R. China
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30
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Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013. J Low Genit Tract Dis 2018; 22:225-230. [PMID: 29649025 DOI: 10.1097/lgt.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR). MATERIALS AND METHODS We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer. RESULTS A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79). CONCLUSIONS Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.
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31
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao EY, Deshmukh AA. Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Netw Open 2018; 1:e181999. [PMID: 30646145 PMCID: PMC6324459 DOI: 10.1001/jamanetworkopen.2018.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs). OBJECTIVES To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression. RESULTS From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased. CONCLUSIONS AND RELEVANCE According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
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Affiliation(s)
- Ryan Suk
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Kalyani Sonawane
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Andrew G. Sikora
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish A. Deshmukh
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
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Janulionis E, Samerdokiene V, Valuckas KP, Atkocius V, Rivard MJ. Second primary malignancies after high-dose-rate 60Co photon or 252Cf neutron brachytherapy in conjunction with external-beam radiotherapy for endometrial cancer. Brachytherapy 2018; 17:768-774. [DOI: 10.1016/j.brachy.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/15/2018] [Accepted: 05/10/2018] [Indexed: 01/17/2023]
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Mahfoud T, Tanz R, Khmamouche RM, El Hammoumi MM, Allaoui M, Belbaraka R, Ichou M. Triple malignancy in a single patient including a squamous cell carcinoma of the cervix, a colloid adenocarcinoma of the colon and a lung adenocarcinoma: A case report and literature review. Int J Surg Case Rep 2018; 41:465-468. [PMID: 29546018 PMCID: PMC5709303 DOI: 10.1016/j.ijscr.2017.11.013] [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: 09/21/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022] Open
Abstract
Triple malignancy in the same patient is exceptional. The etiology remains controversial. The management depend on stages. Surgery is the standard of care in localized cancers.
Introduction The association of two cancers in the same patient is unusual but has been widely reported in the literature, while triple malignancy in the same patient is exceptional. Indeed, only very rare cases have been described. Case presentation A 70-year-old woman treated in our institute in 2006 for a tumor of the cervix. She underwent extrafascial hysterectomy. Pathology revealed a well differentiated squamous cell carcinoma of the cervix (pT1N0M0). No external pelvic radiation or brachytherapy were done. The patient remained in good control until 2013 when she presented a tumor of the ascending colon. A right hemicolectomy was made. Pathology confirmed a colloid adenocarcinoma (pT3N0M0). No adjuvant chemotherapy was given. Three years later, a Computed tomography scan of the chest revealed a nodule of the lower lobe of the left lung. Biopsy was made. Histology with immunochemistry revealed the diagnosis of lung adenocarcinoma. Positron emission tomography scan showed abnormal fluorodeoxyglucose uptake in the lung nodule with no anomaly in mediastinal nodes and no metastasis. A left lower lobectomy was performed with lymph node dissection. Pathology confirmed the diagnosis of 2.5 cm lung adenocarcinoma without node invasion (pT1N0M0). No chemotherapy was given. After 14 months, the patient remained in good control. Conclusions Triple malignancy in a single patient is exceptional. The management depend on stages. Surgery is the standard of care in localized cancers.
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Affiliation(s)
- Tarik Mahfoud
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
| | - Rachid Tanz
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Réda M Khmamouche
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Massine M El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Mohamed Allaoui
- Department of Pathology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Rhizlane Belbaraka
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco; Oncology and Hematology Center, Mohammed IV University Hospital, Marrakech, Morocco.
| | - Mohamed Ichou
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
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Jhamad S, Aanjane R, Jaiswal S, Jain S, Bhagat P. Second Primary Cancer after Radiotherapy for Cervical Cancer. J Midlife Health 2018; 9:207-209. [PMID: 30692817 PMCID: PMC6332716 DOI: 10.4103/jmh.jmh_74_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiation is a treatment for many gynecological malignancies, especially locally advanced cervical cancer. Development of sarcoma due to previous radiation occurs very rarely. They develop within the radiation field. We report a case of carcinosarcoma in our patient developed 8 years after the radiotherapy (RT) that she received in the form of external beam radiation and intracavitary RT along with concomitant chemotherapy consisting of cisplatin. Although the development of secondary primary cancer is rare, for every patient who receives radiation for treatment of cancer, close follow-up is recommended as they may have viable endometrium.
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Affiliation(s)
- Sushma Jhamad
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Rajendra Aanjane
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Sanjog Jaiswal
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Suchita Jain
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Priyanka Bhagat
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
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Nelson RA, Lai LL. Elevated risk of human papillomavirus-related second cancers in survivors of anal canal cancer. Cancer 2017; 123:4013-4021. [DOI: 10.1002/cncr.30828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | - Lily L. Lai
- Department of Surgery; City of Hope; Duarte California
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Chang EHE, Braith A, Hitsman B, Schnoll RA. Treating Nicotine Dependence and Preventing Smoking Relapse in Cancer Patients. EXPERT REVIEW OF QUALITY OF LIFE IN CANCER CARE 2016; 2:23-39. [PMID: 28808692 PMCID: PMC5553981 DOI: 10.1080/23809000.2017.1271981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite the well-documented harmful effects of smoking, many cancer patients continue to smoke. Smoking cessation is critical to address in this population given the associated increase in treatment toxicity, risk of second primary tumors, decrease in treatment response and higher disease-specific and all-cause mortality with continued smoking following a cancer diagnosis. This review seeks to summarize the latest recommendations and guidelines on smoking cessation treatment for patients diagnosed with cancer, and the evidence behind those recommendations. AREAS COVERED We reviewed the latest evidence for smoking cessation treatments for cancer patients and the clinical guidelines and recommendation available for oncologists and health care providers. The unique aspects of nicotine dependence among patients diagnosed with cancer, and key challenges and barriers that cancer survivors and health care providers experience when considering smoking cessation treatments, and available clinical resources, are also discussed. Lastly, the authors summarize future directions in the field of smoking cessation treatment for cancer patients. EXPERT COMMENTARY While there are areas of improvement in research of smoking cessation treatment for cancer patients, critical under-explored areas remain. Nonetheless, providers should adhere to the NCCN guidelines and offer a brief counseling intervention to motivate patients to quit smoking when appropriate resources are not available.
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Affiliation(s)
- Eun Hae Estelle Chang
- Department of Otolaryngology Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, Phone 402-559-8007 Fax 402-559-8490
| | - Andrew Braith
- College of Medicine, University of Nebraska Medical Center, 42 Street and Emile Street, Omaha, NE 68198
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, Phone 312-503-2074
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4 Floor, Philadelphia, PA 19104, Phone 215-746-7143 Fax 215-746-7140
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Neumann F, Jégu J, Mougin C, Prétet JL, Guizard AV, Lapôtre-Ledoux B, Bara S, Bouvier V, Colonna M, Troussard X, Trétarre B, Grosclaude P, Velten M, Woronoff AS. Risk of second primary cancer after a first potentially-human papillomavirus-related cancer: A population-based study. Prev Med 2016; 90:52-8. [PMID: 27370167 DOI: 10.1016/j.ypmed.2016.06.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
Human papillomaviruses (HPV) are involved in the development of anogenital and head and neck cancers. The purpose of this study was to assess the risk of developing a second primary cancer (SPC) after a first potentially-HPV-related cancer, and to analyze the sites where SPCs most frequently occurred in these patients. All patients with a first cancer diagnosed between 1989 and 2004, as recorded by 10 French cancer registries, were followed up until December 31, 2007. Only invasive potentially-HPV-related cancers (namely, cervical, vagina, vulva, anal canal, penile, oropharynx, tongue and tonsil) were included. Standardized Incidence Ratios (SIRs) were calculated to assess the risk of SPC. A multivariate Poisson regression model was used to model SIRs separately by gender, adjusted for the characteristics of the first cancer. 10,127 patients presented a first potentially-HPV-related cancer. The overall SIR was 2.48 (95% CI, 2.34-2.63). The SIR was 3.59 (95% CI, 3.33-3.86) and 1.61 (95% CI, 1.46-1.78) in men and women respectively. The relative risk of potentially-HPV-related SPC was high among these patients (SIR=13.74; 95% CI, 8.80-20.45 and 6.78; 95% CI, 4.61-9.63 for men and women, respectively). Women diagnosed in the most recent period (2000-2004) showed a 40% increase of their relative risk of SPC as compared with women diagnosed between 1989 and 1994 (ratio of SIRs=1.40; 95% CI, 1.06-1.85). HPV cancer survivors face an increased risk of SPC, especially second cancer. Clinicians may consider this increased risk of developing HPV-related SPC during follow-up to improve subsequent cancer prevention in these patients.
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Affiliation(s)
- Florent Neumann
- Registre des tumeurs du Doubs et du Territoire de Belfort, University Hospital Besançon, F-25000 Besançon, France.
| | - Jérémie Jégu
- Registre des cancers du Bas-Rhin, Laboratoire d'Épidémiologie et de Santé Publique, EA3430, FMTS, University of Strasbourg, F-67085 Strasbourg, France; Service de santé publique, University Hospital of Strasbourg, F-67091 Strasbourg, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Christiane Mougin
- University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; University Hospital Besançon, F-25000 Besançon, France
| | - Jean-Luc Prétet
- University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; University Hospital Besançon, F-25000 Besançon, France
| | - Anne-Valérie Guizard
- Registre général des tumeurs du Calvados, Cancers & Préventions - U 1086 Inserm, Centre François Baclesse, F-14076, Caen 05, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Bénédicte Lapôtre-Ledoux
- Registre du cancer de la Somme, Service Épidémiologie Hygiène et Santé Publique, University Hospital Nord, F-80054 Amiens, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Simona Bara
- Registre des cancers de la Manche, Hospital of Cotentin, F-50102 Cherbourg-Octeville, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Véronique Bouvier
- Registre des tumeurs digestives du Calvados, Cancers & Préventions - U 1086 Inserm, Centre François Baclesse, BP 5026, F-14076, Caen 05, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Marc Colonna
- Registre des cancers de l'Isère, University Hospital Grenoble, BP 217, F-38043, Grenoble 9, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Xavier Troussard
- Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n°0350, University Hospital Caen, F-14033 Caen, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Brigitte Trétarre
- Registre des tumeurs de l'Hérault, Centre de Recherche, F-34298, Montpellier 5, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Pascale Grosclaude
- Registre des cancers du Tarn, BP 37, F-81001 Albi, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Michel Velten
- Registre des cancers du Bas-Rhin, Laboratoire d'Épidémiologie et de Santé Publique, EA3430, FMTS, University of Strasbourg, F-67085 Strasbourg, France; Service de santé publique, University Hospital of Strasbourg, F-67091 Strasbourg, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Anne-Sophie Woronoff
- Registre des tumeurs du Doubs et du Territoire de Belfort, University Hospital Besançon, F-25000 Besançon, France; University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
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Clark LH, Kim KH. Tobacco Use and Outcomes in Gynecologic Malignancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Teng CJ, Huon LK, Hu YW, Yeh CM, Chao Y, Yang MH, Chen TJ, Hung YP, Liu CJ. Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1803. [PMID: 26512575 PMCID: PMC4985389 DOI: 10.1097/md.0000000000001803] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022] Open
Abstract
To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.
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Affiliation(s)
- Chung-Jen Teng
- From the Institute of Public Health, National Yang-Ming University, Taipei (C-JT, Yi-PH); Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City (C-JT); School of Medicine, National Yang-Ming University (C-JT, Y-WH, YC, M-HY, T-JC, Yi-PH, C-JL); Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital (L-KH); School of Medicine, Fu Jen Catholic University (L-KH); Department of Oncology (Y-WH, YC); Department of Family Medicine (C-MY, T-JC); Division of Gastroenterology and Hepatology, Department of Medicine (YC); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (M-HY, Yi-PH, C-JL); and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan (C-JL)
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Samerdokiene V, Valuckas KP, Janulionis E, Atkocius V, Rivard MJ. Second primary malignancies after radiotherapy including HDR (252)Cf brachytherapy for cervical cancer. Brachytherapy 2015; 14:898-904. [PMID: 26194049 DOI: 10.1016/j.brachy.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Second primary malignancies (SPMs) are among the most serious late adverse effects after radiotherapy experienced over time by the increasing population of cancer survivors worldwide. The study aim was to determine the rate and distribution of SPMs for neutron- and photon-emitting brachytherapy (BT) sources for patients treated for cervical cancer. METHODS AND MATERIALS The cohort comprised 662 patients with invasive cervical cancer (Stages IIB and IIIB) and contributed 5,224 patient-years (PY) of observation. These patients were treated by radiotherapy during the 1989-1999 year period with cobalt-60 source ((60)Co) teletherapy. The first group of patients (N = 375; 3,154 PY) received high-dose-rate (HDR) californium-252 source ((252)Cf) BT, whereas the second group (N = 287; 2,070 PY) received HDR (60)Co BT. RESULTS Over a 25-year period, 35 SPMs were observed, amounting to 5.3% of all observed patients: in 16 (2.4%) heavily, 2 (0.3%) moderately, 14 (2.1%) lightly irradiated body sites, and 3 (0.5%) other sites. Of these, 21 cases (5.6%) were observed in the HDR (252)Cf BT group, whereas 14 cases (4.9%) were observed in the HDR (60)Co BT group. Exposures received during (60)Co teletherapy and HDR BT with either (252)Cf or (60)Co had statistically equivalent (p = 0.68) effects on SPM development. CONCLUSIONS Cure rates are improving, and therefore, there are more long-term survivors from cervical cancer. This study shows no significant difference in rates or distribution of SPMs in women treated with neutron BT compared with photon BT (p = 0.68). After reviewing related literature and our research results, it is evident that a detailed investigation of SPM frequency, localization, and dose to adjacent organs is a suitable topic for further research.
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Affiliation(s)
- Vitalija Samerdokiene
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania.
| | | | - Ernestas Janulionis
- Radiation and Medical Oncology Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Vydmantas Atkocius
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Mark J Rivard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
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