Increased risk for second primary rectal cancer after pelvic radiation therapy. (January 2020)

• Record Type: Journal Article
• Authors: Rombouts, Anouk J.M.; Hugen, Niek; Elferink, Marloes A.G.; Poortmans, Philip M.P.; Nagtegaal, Iris D.; de Wilt, Johannes H.W.
• Is Part Of: European journal of cancer. Volume 124(2020)
• Page Start: 142
• Page End: 151
• Publication Date: 2020-01
• Subjects: Radiation therapy -- Rectal cancer -- Second cancer -- Radiation-induced cancer -- Prostate cancer -- Endometrial cancer -- Cervical cancer -- Vaginal cancer -- Ovarian cancer -- Bladder cancer; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2019.10.022
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: The aim of this study was to analyse the association between pelvic radiation therapy (RT) and the development of rectal cancer as a second primary cancer. Methods: Data on patients treated for a primary pelvic cancer between 1989 and 2007 were retrieved from the population-based Netherlands Cancer Registry. Patients treated for more than one pelvic cancer were excluded. To estimate the cumulative incidence of rectal cancer, Fine and Gray's competing risk model was used with death as a competing event. Survival was calculated using multivariable Cox regression. Results: A total of 192, 658 patients were included, of which 62, 630 patients were treated with RT for their pelvic cancer. Primary tumours were located in the prostate (50.1%), bladder (19.2%), endometrium (13.9%), ovaries (10.0%), cervix (6.4%) and vagina (0.4%). At a median interval of 6 years (range 0–24), 1369 patients developed a rectal cancer. Overall, the risk for rectal cancer was increased in patients who underwent RT for the previous pelvic cancer (subhazard ratio [SHR]: 1.72, 95% confidence interval [CI]: 1.55–1.91). Analysis for each tumour location specifically showed an increased risk in patients who received RT for prostate (SHR: 1.89, 95% CI: 1.66–2.16) or endometrial cancer (SHR: 1.50, 95% CI: 1.13–2.00). A protective effect of RT was observed for patients with bladder cancer (SHR 0.67, 95% CI: 0.47–0.94). There was no survival difference between patients with rectal cancer with or without previous RT (hazard ratio: 0.94, 95% CI: 0.79–1.11). Conclusions: Patients who received RT for a previous pelvic cancer were at increased risk for rectal cancer. The risk was modest and pronounced in patients receiving RT for prostate and endometrial cancer. Highlights: Overall, patients receiving pelvic radiation were at increased risk for rectal cancer. Rectal cancer risk was increased after RT for prostate and endometrial cancer. No increased risk after RT for bladder, ovarian, cervical and vaginal cancer. Survival did not differ between patients with rectal cancer with or without previous RT.