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Risk of second non-breast cancer after radiotherapy for breast cancer: a systematic review and meta-analysis of 762,468 patients.

Authors :
Grantzau T
Overgaard J
Source :
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2015 Jan; Vol. 114 (1), pp. 56-65. Date of Electronic Publication: 2014 Nov 07.
Publication Year :
2015

Abstract

Background and Purpose: Radiotherapy for breast cancer both decreases loco-regional recurrence rates and improves overall survival. However, radiotherapy has also been associated with increased second cancer risk at exposed sites. In this meta-analysis, we estimated the risk of second non-breast cancers after radiotherapy for breast cancer.<br />Material and Methods: The databases Medline/Pubmed, Cochrane, Embase and Cinahl were systematically searched, for cohort studies on second cancer after radiotherapy for breast cancer, from inception to August 1st 2013. Included studies were to report the relative risk (RR) of second cancers comparing irradiated female breast cancer patients to unirradiated patients. Primary endpoints were all second non-breast-cancers and second cancers of the lung, esophagus, thyroid and second sarcomas. RRs were pooled using random-effects meta-analysis.<br />Results: Thirteen studies comprising 762,468 breast cancer patients were included in the meta-analysis. Five or more years after breast cancer diagnosis radiotherapy was significantly associated with an increased risk of second non-breast cancer RR 1.12 (95% confidence interval [CI] 1.06-1.19), second cancer of the lung RR 1.39 (95% CI 1.28-1.51), esophagus RR 1.53 (95% CI 1.01-2.31) and second sarcomas RR 2.53 (95% CI 1.74-3.70). The risk increased over time, and was highest 15 or more years after breast cancer diagnosis, for second lung RR 1.66 (95% CI 1.36-2.01) and second esophagus cancer RR 2.17 (95% CI 1.11-4.25). There was no significant association between radiotherapy and second thyroid cancer.<br />Conclusions: Radiotherapy for breast cancer is significantly associated with increased risks of second non-breast cancer, overall and in organs adjacent to the previous treatment fields. Despite a relative small absolute risk, the growing number of long-time survivors after breast cancer warrants the need for normal tissue sparing radiotherapy techniques.<br /> (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1879-0887
Volume :
114
Issue :
1
Database :
MEDLINE
Journal :
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Publication Type :
Academic Journal
Accession number :
25454172
Full Text :
https://doi.org/10.1016/j.radonc.2014.10.004