Second malignancies in breast cancer patients following radiotherapy: a study in Florence, Italy

Abstract

IntroductionPatients diagnosed with breast cancer are often treated with surgery followed by radiation therapy. In this paper, we evaluate the effect that radiotherapy may have had on the subsequent risk of second malignancies, including the possible influences of age at treatment and menopausal status.MethodsIn order to evaluate the long-term consequences of radiotherapy, a cohort study was conducted based on clinical records for 5,248 women treated for breast cancer in Florence (Italy), with continuous follow-up from 1965 to 1994. The Cox proportional hazards model for ungrouped survival data was used to estimate the relative risk for second cancer after radiotherapy.ResultsThis study indicated an increased relative risk of all second cancers combined following radiotherapy (1.22, 95% CI: 0.88 to 1.69). The increased relative risk appeared five or more years after radiotherapy and appeared to be highest amongst women treated after the menopause (1.61, 95% CI: 1.13 to 2.29). Increased relative risks were observed specifically for leukaemia (8.13, 95% CI: 0.96 to 69.1) and other solid cancers (1.84, 95% CI: 1.06 to 3.16), excluding contralateral breast cancer. For contralateral breast cancer, no raised relative risk was observed during the period more than five years after radiotherapy.ConclusionsThe study indicated a raised risk of second malignancies associated with radiotherapy for breast cancer, particularly for women treated after the menopause.

Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients

“…A statistical increase in relative risk of CBC after RT has been reported using the SEER data base, and that the risk was dose-dependent [27]. On the other hand, no raised relative risk of CBC was observed in other studies [28][29][30].…”

The Role of Active Breathing Control-Moderate Deep Inspiration Breath-Hold (ABC-mDIBH) Usage in non-Mastectomized Left-sided Breast Cancer Radiotherapy: A Dosimetric Evaluation

“…RT-induced second malignancies are also of great concern in this patient group given the young average age at diagnosis and excellent survival. 15,16 Integrating respiratory management strate- gies into breast cancer RT has been widely studied in the past few years. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Our study primarily aimed at investigating the dosimetric impact of ABC-mDIBH on critical organ dose-volume parameters, and we found statistically significant reductions in heart, LAD, lung, and contralateral breast doses.…”

“…Second malignancies also deserve utmost attention particu-larly in long-term survivors of breast cancer. 15,16 In many studies conducted so far, particularly deaths from cardiac events contributed to the increase in non-breast cancer mortality. 5, 10,11,[17][18][19][20][21][22][23][24][25] Cardiac morbidity and mortality is an important concern particularly in left-sided breast cancer patients who have a higher risk of having coronary artery disease, chest pain, and myocardial infarction.…”

Therapy–Related Acute Myeloid Leukaemia Following Concurrent Radiotherapy and Chemotherapy for Humerus Angiosarcoma

“…A cohort study analyzing chemical records of breast cancer patients with the aim of evaluating the long term effects of radiotherapy on the risk of second cancers reported a total of 389 (7.3%) malignancies in 5248 women [14]. Eight (0.15%) patients treated with radiotherapy developed leukaemia in the group as oppose to one case only in the group not receiving radiotherapy [14].…”