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Wang Y, Song W, Wang H, Zhu G, Li Y, Wang Z, Li W, Che G. Increased risk of subsequent primary lung cancer among female hormone-related cancer patients: A meta-analysis based on over four million cases. Chin Med J (Engl) 2024; 137:1790-1801. [PMID: 38973242 DOI: 10.1097/cm9.0000000000003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The incidence rate of lung cancer in women has significantly increased over the past decade, and previous evidence has indicated a significant relationship between the elevated levels of sex hormones and the risk of lung cancer. Therefore, we hypothesized that female hormone-related cancer (FHRC) patients, including breast, endometrial, cervical, and ovarian cancer patients, may experience a higher risk of developing subsequent lung cancer. This meta-analysis aimed to identify the risk of lung cancer among FHRC patients compared to the general population. METHODS The PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI databases were searched up to May 11, 2022. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were used to identify the risk of subsequent lung cancer after FHRC. Subgroup analyses based on the follow-up time and tumor type were also conducted. RESULTS A total of 58 retrospective cohort studies involving 4,360,723 FHRC participants were included. The pooled results demonstrated that FHRC patients had a significantly increased risk of developing subsequent primary lung cancer (SIR = 1.61, 95% CI: 1.48-1.76, P <0.001). Subgroup analysis revealed an obvious trend of increasing lung cancer risk over time (SIRs for <5 years, ≥5 years, ≥10 years, ≥20 years, and ≥30 years after FHRC: 1.32, 1.59, 1.57, 1.68, and 1.95, respectively). In addition, subgroup analysis stratified by tumor type indicated an increased risk of developing subsequent lung cancer after breast (SIR = 1.25, P <0.001), endometrial (SIR = 1.40, P = 0.019), cervical (SIR = 2.56, P <0.001), and ovarian cancer (SIR = 1.50, P = 0.010). CONCLUSION FHRC patients are more likely to develop lung cancer than the general population. Furthermore, the increased risk of subsequent primary lung cancer is more obvious with a longer survival time and is observed in all types of hormone-related cancer. REGISTRATION International Platform of Registered Systematic Review and Meta-analysis Protocols: No. INPLASY202270044; https://inplasy.com/.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenpeng Song
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Haoyu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guonian Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yangqian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhoufeng Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Networks, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Networks, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Wang Y, Li J, Chang S, Dong Y, Che G. Risk and Influencing Factors for Subsequent Primary Lung Cancer After Treatment of Breast Cancer: A Systematic Review and Two Meta-Analyses Based on Four Million Cases. J Thorac Oncol 2021; 16:1893-1908. [PMID: 34256110 DOI: 10.1016/j.jtho.2021.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION To compare the risk of developing lung cancer between patients with breast cancer and the general population and explore the risk factors for the development of primary lung cancer after treatment for breast cancer. METHODS The PubMed, EMBASE, and Web of Science databases were searched from the establishment date to October 11, 2020. Two separate meta-analyses were performed: one focused on studies reporting the risk of subsequent lung cancer after breast cancer and one focused on studies exploring the risk factors for subsequent lung cancer in patients with breast cancer. The standardized incidence ratios with 95% confidence intervals were combined to compare the risk of developing lung cancer between patients with breast cancer and the general population. The relative risks (RRs) or ORs with 95% confidence intervals were combined to assess the association of clinicopathological parameters with the risk of developing lung cancer after breast cancer. All statistical analyses were conducted by STATA 12.0. RESULTS A total of 15 studies involving 1,161,979 patients were eventually included in the first meta-analysis, and the pooled results indicated that female patients with breast cancer revealed a significantly higher risk of developing subsequent lung cancer (standardized incidence ratio = 1.25, p < 0.001). In addition, a total of 22 articles involving 3,090,620 patients were included in the second meta-analysis. The pooled results indicated that smoking (OR = 9.73, p < 0.001) and radiotherapy (RR = 1.40, p < 0.001) were risk factors for developing subsequent lung cancer in patients with breast cancer, and chemotherapy (RR = 0.69, p = 0.002), positive estrogen receptor status (RR = 0.93, p = 0.014) and positive progesterone receptor status (RR = 0.86, p < 0.001) were protective factors. Meanwhile, subgroup analysis based on the relative position of the breast and lung cancers (ipsilateral versus contralateral) was conducted, which indicated that radiotherapy only increased the risk of ipsilateral lung cancer in patients with breast cancer (RR = 1.27, p = 0.001). CONCLUSIONS Patients with breast cancer are more likely to develop lung cancer than the general population, and the risk of developing primary lung cancer after breast cancer is affected by smoking, radiotherapy, chemotherapy, estrogen receptor status and progesterone receptor status.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jialong Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Benveniste MF, Gomez D, Carter BW, Betancourt Cuellar SL, Shroff GS, Benveniste APA, Odisio EG, Marom EM. Recognizing Radiation Therapy-related Complications in the Chest. Radiographics 2020; 39:344-366. [PMID: 30844346 DOI: 10.1148/rg.2019180061] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Radiation therapy is one of the cornerstones for the treatment of thoracic malignancies. Although advances in radiation therapy technology have improved the delivery of radiation considerably, adverse effects are still common. Postirradiation changes affect the organ or tissue treated and the neighboring structures. Advances in external-beam radiation delivery techniques and how these techniques affect the expected thoracic radiation-induced changes are described. In addition, how to distinguish these expected changes from complications such as infection and radiation-induced malignancy, and identify treatment failure, that is, local tumor recurrence, is reviewed. ©RSNA, 2019.
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Affiliation(s)
- Marcelo F Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Daniel Gomez
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Brett W Carter
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Sonia L Betancourt Cuellar
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Ana Paula A Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Erika G Odisio
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
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Rehman JU, Isa M, Ahmad N, Nasar G, Asghar HMNUHK, Gilani ZA, Chow JCL, Afzal M, Ibbott GS. Dosimetric, Radiobiological and Secondary Cancer Risk Evaluation in Head-and-Neck Three-dimensional Conformal Radiation Therapy, Intensity-Modulated Radiation Therapy, and Volumetric Modulated Arc Therapy: A Phantom Study. J Med Phys 2018; 43:129-135. [PMID: 29962691 PMCID: PMC6020619 DOI: 10.4103/jmp.jmp_106_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/02/2022] Open
Abstract
This analysis estimated secondary cancer risks after volumetric modulated arc therapy (VMAT) and compared those risks to the risks associated with other modalities of head-and-neck (H&N) radiotherapy. Images of H&N anthropomorphic phantom were acquired with a computed tomography scanner and exported via digital imaging and communications in medicine (DICOM) standards to a treatment planning system. Treatment plans were performed using a VMAT dual-arc technique, a nine-field intensity-modulated radiation therapy (IMRT) technique, and a four-field three-dimensional conformal therapy (3DCRT) technique. The prescription dose was 66.0 Gy for all three techniques, but to accommodate the range of dosimeter responses, we delivered a single dose of 6.60 Gy to the isocenter. The lifetime risk for secondary cancers was estimated according to National Council on Radiation Protection and Measurements (NCRP) Report 116. VMAT delivered the lowest maximum doses to esophagus (23 Gy), and normal brain (40 Gy). In comparison, maximum doses for 3DCRT were 74% and 40%, higher than those for VMAT for the esophagus, and normal brain, respectively. The normal tissue complication probability and equivalent uniform dose for the brain (2.1%, 0.9%, 0.8% and 3.8 Gy, 2.6 Gy, 2.3 Gy) and esophagus (4.2%, 0.7%, 0.4% and 3.7 Gy, 2.2 Gy, 1.8 Gy) were calculated for the 3DCRT, IMRT and VMAT respectively. Fractional esophagus OAR volumes receiving more than 20 Gy were 3.6% for VMAT, 23.6% for IMRT, and 100% for 3DCRT. The calculations for mean doses, NTCP, EUD and OAR volumes suggest that the risk of secondary cancer induction after VMAT is lower than after IMRT and 3DCRT.
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Affiliation(s)
- Jalil Ur Rehman
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Muhammad Isa
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Toronto, Canada
- Department of Physics, Hafiz Hayat Campus, University of Gujrat, Gujrat, Pakistan
| | - Nisar Ahmad
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Gulfam Nasar
- Department of Chemistry, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - H. M. Noor Ul Huda Khan Asghar
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Zaheer Abbas Gilani
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - James C. L. Chow
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Toronto, Canada
| | - Muhammad Afzal
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Grantzau T, Overgaard J. Risk of second non-breast cancer among patients treated with and without postoperative radiotherapy for primary breast cancer: A systematic review and meta-analysis of population-based studies including 522,739 patients. Radiother Oncol 2016; 121:402-413. [DOI: 10.1016/j.radonc.2016.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/28/2016] [Accepted: 08/28/2016] [Indexed: 12/20/2022]
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The Urtica dioica extract enhances sensitivity of paclitaxel drug to MDA-MB-468 breast cancer cells. Biomed Pharmacother 2016; 83:835-842. [PMID: 27501501 DOI: 10.1016/j.biopha.2016.07.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Due to the chemo resistant nature of cancer cells and adverse effects of current therapies, researchers are looking for the most efficient therapeutic approach which has the lowest side effects and the highest toxicity on cancer cells. The aim of the present study was to investigate the synergic effect of Urtica dioica extract in combination with paclitaxel on cell death and invasion of human breast cancer MDA-MB-468 cell line. MATERIALS AND METHODS To determine the cytotoxic effects of Urtica dioica extract with paclitaxel, MTT assay was performed. The scratch test was exploited to assess the effects of Urtica dioica, Paclitaxel alone and combination on migration of cancer cells. The expression levels of snail-1, ZEB1, ZEB2, twist, Cdc2, cyclin B1 and Wee1 genes were quantified using qRT-PCR and western blot performed for snail-1expression. The effects of plant extract, Paclitaxel alone and combination on different phases of cell cycle was analyzed using flow cytometry. RESULTS Results of MTT assay showed that Urtica dioica significantly destroyed cancer cells. Interestingly, Concurrent use of Urtica dioica extract with paclitaxel resulted in decreased IC50 dose of paclitaxel. Moreover, findings of scratch assay exhibited the inhibitory effects of Urtica dioica, Paclitaxel alone and combination on migration of MDA-MB-468 cell line. Our findings also demonstrated that the extract substantially decreased the Snail-1 and related gene expression. Ultimately, Cell cycle arrest occurred at G2/M phase post-treatment by deregulating Cdc2 and wee1. CONCLUSIONS Our results demonstrated that the dichloromethane extract of Urtica dioica inhibit cell growth and migration. Also, Urtica dioica extract substantially increased sensitivity of breast cancer cells to paclitaxel. Therefore, it can be used as a potential candidate for treatment of breast cancer with paclitaxel.
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Rehman JU, Tailor RC, Isa M, Afzal M, Chow J, Ibbott GS. Evaluations of secondary cancer risk in spine radiotherapy using 3DCRT, IMRT, and VMAT: A phantom study. Med Dosim 2014; 40:70-5. [PMID: 25434808 DOI: 10.1016/j.meddos.2014.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 10/18/2014] [Accepted: 10/21/2014] [Indexed: 11/16/2022]
Abstract
This study evaluated the secondary cancer risk from volumetric-modulated arc therapy (VMAT) for spine radiotherapy compared with intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3DCRT). Computed tomography images of an Radiological Physics Center spine anthropomorphic phantom were exported to a treatment planning system (Pinnacle(3), version 9.4). Radiation treatment plans for spine were prepared using VMAT (dual-arc), 7-field IMRT (beam angles: 110°, 130°, 150°, 180°, 210°, 230°, and 250°), and 4-field 3DCRT technique. The mean and maximum doses, dose-volume histograms, and volumes receiving more than 2 and 4Gy to organs at risk (OARs) were calculated and compared. The lifetime risk for secondary cancers was estimated according to the National Cancer Registry Programme Report 116. VMAT delivered the lowest maximum dose to the esophagus (4.03Gy), bone (8.11Gy), heart (2.11Gy), spinal cord (6.45Gy), and whole lung (5.66Gy) as compared with other techniques (IMRT and 3DCRT). The volumes of OAR (esophagus) receiving more than 4Gy were 0% for VMAT, 27.06% for IMRT, and up to 32.35% for 3DCRT. The estimated risk for secondary cancer in the respective OAR is considerably lower in VMAT compared with other techniques. The results of maximum doses and volumes of OARs suggest that the risk of secondary cancer induction for the spine in VMAT is lower than IMRT and 3DCRT, whereas VMAT has the best target coverage compared with the other techniques.
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Affiliation(s)
- Jalil ur Rehman
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan; Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX.
| | - Ramesh C Tailor
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX
| | - Muhammad Isa
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan; Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Muhammad Afzal
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - James Chow
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Geoffrey S Ibbott
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX
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Braunstein S, Nakamura JL. Radiotherapy-induced malignancies: review of clinical features, pathobiology, and evolving approaches for mitigating risk. Front Oncol 2013; 3:73. [PMID: 23565507 PMCID: PMC3615242 DOI: 10.3389/fonc.2013.00073] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/21/2013] [Indexed: 12/24/2022] Open
Abstract
One of the most significant effects of radiation therapy on normal tissues is mutagenesis, which is the basis for radiation-induced malignancies. Radiation-induced malignancies are late complications arising after radiotherapy, increasing in frequency among survivors of both pediatric and adult cancers. Genetic backgrounds harboring germline mutations in tumor suppressor genes are recognized risk factors. Some success has been found with using genome wide association studies to identify germline polymorphisms associated with susceptibility. The insights generated by genetics, epidemiology, and the development of experimental models are defining potential strategies to offer to individuals at risk for radiation-induced malignancies. Concurrent technological efforts are developing novel radiotherapy delivery to reduce irradiation of normal tissues, and thereby, to mitigate the risk of radiation-induced malignancies. The goal of this review is to discuss epidemiologic, modeling, and radiotherapy delivery data, where these lines of research intersect and their potential impact on patient care.
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Affiliation(s)
- Steve Braunstein
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
| | - Jean L. Nakamura
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
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Bouillon K, Haddy N, Delaloge S, Garbay JR, Garsi JP, Brindel P, Mousannif A, Lê MG, Labbe M, Arriagada R, Jougla E, Chavaudra J, Diallo I, Rubino C, de Vathaire F. Long-Term Cardiovascular Mortality After Radiotherapy for Breast Cancer. J Am Coll Cardiol 2011; 57:445-52. [DOI: 10.1016/j.jacc.2010.08.638] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 07/13/2010] [Accepted: 08/10/2010] [Indexed: 10/18/2022]
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Li CI, Nishi N, McDougall JA, Semmens EO, Sugiyama H, Soda M, Sakata R, Hayashi M, Kasagi F, Suyama A, Mabuchi K, Davis S, Kodama K, Kopecky KJ. Relationship between radiation exposure and risk of second primary cancers among atomic bomb survivors. Cancer Res 2010; 70:7187-98. [PMID: 20843820 DOI: 10.1158/0008-5472.can-10-0276] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation exposure is related to risk of numerous types of cancer, but relatively little is known about its effect on risk of multiple primary cancers. Using follow-up data through 2002 from 77,752 Japanese atomic bomb survivors, we identified 14,048 participants diagnosed with a first primary cancer, of whom 1,088 were diagnosed with a second primary cancer. Relationships between radiation exposure and risks of first and second primary cancers were quantified using Poisson regression. There was a similar linear dose-response relationship between radiation exposure and risks of both first and second primary solid tumors [excess relative risk (ERR)/Gy = 0.65; 95% confidence interval (CI), 0.57-0.74 and ERR/Gy = 0.56; 95% CI, 0.33-0.80, respectively] and risk of both first and second primary leukemias (ERR/Gy = 2.65; 95% CI, 1.78-3.78 and ERR/Gy = 3.65; 95% CI, 0.96-10.70, respectively). Background incidence rates were higher for second solid cancers, compared with first solid cancers, until about age 70 years for men and 80 years for women (P < 0.0001), but radiation-related ERRs did not differ between first and second primary solid cancers (P = 0.70). Radiation dose was most strongly related to risk of solid tumors that are radiation-sensitive including second primary lung, colon, female breast, thyroid, and bladder cancers. Radiation exposure confers equally high relative risks of second primary cancers as first primary cancers. Radiation is a potent carcinogen and those with substantial exposures who are diagnosed with a first primary cancer should be carefully screened for second primary cancers, particularly for cancers that are radiation-sensitive.
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Affiliation(s)
- Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Departments of Epidemiology and Biostatistics, University of Washington, Seattle, WA 98109-1024, USA.
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Andersson M, Jensen MB, Engholm G, Henrik Storm H. Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977-2001. Acta Oncol 2009; 47:755-64. [PMID: 18465345 DOI: 10.1080/02841860801978921] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breast cancer survivors have increased risks of developing second primary cancers due to shared etiology, life style factors but also to primary breast cancer treatment. Among 53 418 patients registered by the population based Danish Breast Cancer Cooperative Group (DBCG) during 1977-2001, 31 818 patients were treated and followed according to guidelines of DBCG. In addition to surgery 23% received tamoxifen, 23% chemotherapy and 35% radiotherapy as treatment for primary breast cancer. Second primary cancers were identified by linkage to the population based Danish Cancer Register. Cancer incidence rates of the Danish population were used for calculation of standardized incidence ratios (SIRs). Time at risk was from diagnosis of breast cancer+1 year until death or through 2002. Risk for all second primary cancers combined was increased, SIR=1.04 (95% confidence interval 0.99-1.08). Sites with significantly elevated risks included corpus uteri (SIR=1.23), ovary (1.39), soft tissues (2.24), acute leukaemia (2.02), and sites potentially inducible by breast cancer radiotherapy combined (1.11). For irradiated patients compared to non-irradiated the risk was increased for all sited combined, radiotherapy-related sites, colon and soft tissues. Tamoxifen treated had, compared to non-treated, elevated risk for cancer of corpus uteri (SIR=1.83 vs 1.04). Patients given adjuvant chemotherapy had, compared to those not, elevated risks for all sites combined (SIR=1.24 vs 1.01) and for ovary (2.16 vs 1.24). Risk for cancer of the lung, uterus and ovary was analysed using multivariate Poisson regression. For lung cancer the risk was related to radiotherapy and time since diagnosis, the relative risk for lung cancer being 1.33 (95% CI 1.00-1.77) (irradiated vs non-irradiated). Ovary cancer risk was inversely related to age at diagnosis but not to treatment and corpus uteri cancer risk related to tamoxifen treatment, relative risk 1.57. The findings are in accordance to other population based studies.
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Abstract
The development of malignant lymphoma following breast cancer has not been described before. Here we report the development of malignant lymphoma at the ipsilateral chest wall subsequent to the surgical treatment of breast cancer. A 48-year-old woman underwent modified radical mastectomy due to breast carcinoma. Tamoxifen (10 mg twice daily) was given 3 years after the operation and continued for about 3 years. The patient was well until she recently (17 years after the initial operation) noted a small lump at her left anterior chest wall near the axilla. The local tumour mass was initially assumed to be a local recurrent lesion of breast cancer. Excisional biopsy was performed and eventually was histologically diagnosed to be malignant lymphoma. In view of the therapeutic implication, the development of second malignancy should not be mistaken as a progression of the known primary malignancy. Only with the awareness of such entity, can the prompt diagnosis and proper treatment be achieved.
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Affiliation(s)
- S-M Sheen-Chen
- Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, College of Medicine, Chang Gung University, Taiwan.
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14
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de Vathaire F, Haddy N, Diallo I. Cancers secondaires des radiothérapies. ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Brown LM, Chen BE, Pfeiffer RM, Schairer C, Hall P, Storm H, Pukkala E, Langmark F, Kaijser M, Andersson M, Joensuu H, Fosså SD, Travis LB. Risk of second non-hematological malignancies among 376,825 breast cancer survivors. Breast Cancer Res Treat 2007; 106:439-51. [PMID: 17277968 DOI: 10.1007/s10549-007-9509-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 01/01/2007] [Indexed: 10/23/2022]
Abstract
Breast cancer survivors are at increased risk of treatment-related second cancers. This study is the first to examine risk 30 or more years after diagnosis and to present absolute risks of second cancer which accounts for competing mortality. We identified 23,158 second non-hematological malignancies excluding breast in a population-based cohort of 376,825 one-year survivors of breast cancer diagnosed from 1943 to 2002 and reported to four Scandinavian cancer registries. We calculated standardized incidence ratios (SIR) and utilized a competing-risk model to calculate absolute risk of developing second cancers. The overall SIR for second cancers was 1.15 (95% confidence interval [CI] = 1.14-1.17). The SIR for potentially radiotherapy-associated cancers 30 or more years after breast cancer diagnosis was 2.19 (95% CI = 1.87-2.55). However, the largest SIRs were observed for women aged <40 years followed for 1-9 years. At 20 years after breast cancer diagnosis, the absolute risk of developing a second cancer ranged from 0.6 to 10.3%, depending on stage and age; the difference in the absolute risk compared to the background population was greatest for women aged <40 years with localized disease, 2.3%. At 30 years post breast cancer diagnosis, this difference reached 3.2%. These risks were small compared to the corresponding risk of dying from breast cancer. Although the absolute risks were small, we found persistent risks of second non-hematological malignancies excluding breast 30 or more years after breast cancer diagnosis, particularly for women diagnosed at young ages with localized disease.
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Affiliation(s)
- Linda Morris Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd, MSC 7244, Bethesda, MD 20892-7244, USA.
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16
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Prochazka M, Hall P, Gagliardi G, Granath F, Nilsson BN, Shields PG, Tennis M, Czene K. Ionizing radiation and tobacco use increases the risk of a subsequent lung carcinoma in women with breast cancer: case-only design. J Clin Oncol 2005; 23:7467-74. [PMID: 16234513 DOI: 10.1200/jco.2005.01.7335] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To analyze the risk of lung cancer in women treated with radiotherapy for breast cancer. We accessed the lung dose in relation to different radiotherapy techniques, provided the excess relative risk (ERR) estimate for radiation-associated lung cancer, and evaluated the influence of tobacco use. PATIENTS AND METHODS The Swedish Cancer Registry was used to identify 182 women diagnosed with breast and subsequent lung cancers in Stockholm County during 1958 to 2000. Radiotherapy was administered to 116 patients. Radiation dose was estimated from the original treatment charts, and information on smoking history was searched for in case records and among relatives. The risk of lung cancer was assessed in a case-only approach, where each woman contributed a pair of lungs. RESULTS The average mean lung dose to the ipsilateral lung was 17.2 Gy (range, 7.1 to 32.0 Gy). A significantly increased relative risk (RR) of a subsequent ipsilateral lung cancer was observed at > or = 10 years of follow-up (RR = 2.04; 95% CI, 1.24 to 3.36). Squamous cell carcinoma (RR = 4.00; 95% CI, 1.50 to 10.66) was the histopathologic subgroup most closely related to ionizing radiation. The effect of radiotherapy was restricted to smokers only (RR = 3.08; 95% CI, 1.61 to 5.91). The ERR/Gy for women with latency > or = 10 years after exposure was 0.11 (95% CI, 0.02 to 0.44). CONCLUSION Radiotherapy for breast cancer significantly increases the risk of lung carcinoma more than 10 years after exposure in women who smoked at time of breast cancer.
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Affiliation(s)
- Michaela Prochazka
- Department of Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden.
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17
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Abstract
Breast irradiation, adjuvant chemotherapy, and tamoxifen are associated with an increased risk of second cancers that may manifest decades after treatment. Although very small, it is nonetheless important for clinicians and women to be aware of and to recognize the risk. Postmastectomy irradiation is associated with a slight increase in the risk of developing a sarcoma or lung cancer after a latency period of more than 10 years. However, the majority of information on radiation-associated cancers is derived from large tumor registries, which reflect outdated radiation treatment practices. Modern treatment approaches, which use lower fraction size (or dose) and limit the exposure of surrounding normal tissue to radiation, are less likely to cause radiation-associated cancers. Adjuvant chemotherapy is not associated with any detectable increased risk of solid tumors beyond that which occurs as the population ages. However, alkylating agents, such as cyclophosphamide, and the topoisomerase II inhibitors, doxorubicin and epirubicin, are associated with two types of cytogenetically distinct leukemias after adjuvant chemotherapy. The absolute risk of developing leukemia is lower by orders of magnitude than the improvement in breast cancer mortality that results from adjuvant chemotherapy. Tamoxifen is associated with a two- to threefold increase in the risk of developing endometrial cancer, or about 80 excess cases per 10,000 treated women at 10 years. The benefits of adjuvant therapy outweigh the risks of developing second cancers. Additional studies are needed to more precisely identify patients who are or are not likely to benefit from adjuvant therapy, and individual host and treatment factors that influence the development of second cancer.
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Rubino C, Vathaire FD, Shamsaldin A, Labbe M, Lê MG. Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment. Br J Cancer 2003; 89:840-6. [PMID: 12942115 PMCID: PMC2394476 DOI: 10.1038/sj.bjc.6601138] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In total, 281 of the 7711 women who were initially treated for breast cancer between 1954 and 1983 at the Gustave Roussy Institute developed a second malignant neoplasm (SMN) other than second primary breast cancer and nonmelanoma skin cancer at least 1 year after breast cancer treatment. We carried out a nested case-control study to determine the overall relationship between the dose of radiotherapy received at a given anatomical site and the risk of SMN at the same site. In total, 75% of the cases of SMN were previously treated by radiotherapy, as compared to 73% of the controls. In the irradiated patients, the median local dose was higher among cases (3.1 Gy) than among controls (1.3 Gy). More than 40% of the irradiated patients received a local dose of less than 1 Gy. A purely quadratic relationship was observed between the dose of radiation received at an anatomical site and the risk of SMN at this site. According to the quadratic model, the excess risk of SMN was 0.2% (95% CI 0.05-0.5%) when the target organ received 1 Gy. This risk did not differ significantly according to age at the time of radiotherapy (<40 vs >or=40 years). The risk of SMN was 6.7-fold higher for doses of 25 Gy or more than in the absence of radiotherapy. No carcinogenic effect of chemotherapy was observed and a dose-effect relationship between the length of tamoxifen treatment and SMN occurrence was found. This relationship was limited to endometrial cancers and did not modify the relationship with radiation dose. Our results suggest that high radiation doses slightly increase the risk of second malignancies after breast cancer.
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Affiliation(s)
- C Rubino
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - F de Vathaire
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France. E-mail:
| | - A Shamsaldin
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
- Unit of Radiophysic, Institut Gustave Roussy, Villejuif, France
| | - M Labbe
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
| | - M G Lê
- Unité INSERM XUR521, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
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