Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study

Abstract

Background The most common form of treatment for non-metastatic lung cancer is surgery-based combination therapy, which may also include adjuvant radiotherapy or chemotherapy. Second primary malignancies (SPMs) are uncommon but significant radiation side effects in patients with resectable lung cancer, and SPMs have not been adequately investigated. Our study aims to assess the correlations of radiotherapy with the development of SPMs in patients with resectable lung cancer. Methods We screened for any primary malignancy that occurred more than five years after the diagnosis of resectable lung cancer. Based on the large cohort of the Surveillance, Epidemiology and End Results database, radiotherapy-correlated risks were estimated using the Poisson regression analysis and the cumulative incidence of SPMs was calculated using Fine-Gray competing risk regression analysis. Results Among the 62,435 patients with non-metastatic lung cancer undergoing surgery, a total of 11,341 (18.16%) patients have received radiotherapy. Our findings indicated that radiotherapy was substantially related to a high risk of main second solid malignancies (RR = 1.21; 95%CI, 1.08 to 1.35) and a negligible risk of main second hematologic malignancies (RR = 1.08; 95%CI, 0.84 to 1.37). With the greatest number of patients, the risk of acquiring a second primary gastrointestinal cancer was the highest overall (RR = 1.77; 95 percent CI, 1.44 to 2.15). The cumulative incidence and standardized incidence ratios of SPMs revealed similar findings. Furthermore, the young and the elderly may be more vulnerable, and the highest risk of acquiring most SPMs was seen more than ten years after lung cancer diagnosis. Additionally, more attention should be paid to the second primary gastrointestinal cancer in young individuals with resectable lung cancer. Conclusion After receiving radiotherapy, an increased risk of developing second primary solid and gastrointestinal cancers was observed for patients with resectable lung cancer. The prevention of SPMs associated with radiotherapy requires further attention.

Postoperative radiotherapy does not improve survival in patients with Masaoka-Koga stage IIB thymomas: A propensity score matching study based on the SEER database

“…Mediastinal radiation therapy has the potential to cause harm to irradiated organs, leading to acute or chronic side effects, such as radiation pneumonitis, chronic pulmonary fibrosis, pericarditis, congestive heart failure, myocardial infarction, and valvular heart disease, [19][20][21][22][23] and even the development of radiationinduced secondary malignancies. [24,25] Guidelines developed by Ontario Health (Cancer Care Ontario)'s Program in Evidence-Based Care in collaboration with the Lung Cancer Disease Site Group have concluded that PORT does not yield satisfactory outcomes for patients with Masaoka-Koga stage II thymomas. Due to the potential risk of radiation toxicity, the Working Group does not routinely recommend PORT therapy for these patients.…”

A mast cell-related prognostic model for non-small cell lung cancer

“…Lung cancer has one of the highest fatality rates among malignant tumors in China ( 21 , 22 ). Compared with small cell lung cancer, NSCLC has a slow onset and growth rate but is generally found to be in an advanced stage at initial diagnosis and, therefore, very difficult to control and treat ( 23 - 25 ).…”

Genomic characteristics and immune landscape of super multiple primary lung cancer

“… 1 , 2 , 3 Nowadays, with the prevalence of low-dose computed tomography (LDCT), 4 a significantly greater number of patients with multiple indeterminate pulmonary nodules (IPNs) has been identified, most of which are recognized as multiple primary lung cancer (MPLC). 5 , 6 , 7 A subset of these patients is found to have a large number of lesions at the time of diagnosis, such as around ten or even dozens. These special cases are referred to as ‘super MPLC’.…”