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Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation(Open Access)

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机构： [1]Department of Endocrine and Breast Surgery, The First Affiliated hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China [2]Key Laboratory ofMolecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China [3]Department of Oncology-Pathology, Karolinska Institutet,Stockholm, Sweden [4]West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China [5]Department of Oncology, Shanghai Medical College, FudanUniversity, Shanghai, China [6]Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China [7]Department of Epidemiology, Fairbanks School ofPublic Health and Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, 1050 Wishard Boulevard RG5118, Indianapolis, IN, USA [8]The First Department ofHepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China [9]Department of Hepatobiliary Surgery, the Second Affiliated Hospital of ChongqingMedical University, Chongqing, China [10]Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University,Augusta, GA, USA [11]Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden [12]Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic,Cleveland, OH, USA

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The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term have increased risks of secondary hematologic malignancies (SHM), especially for low/intermediate-risk subsets with limited benefits from RT. DCIS patients in Surveillance, Epidemiology, and End Results (SEER) registries (1975–2016) were identified. Relative risks (RR), hazard ratio (HR), and standardized incidence ratios (SIR) were calculated to assess the SHM risk and subsequent survival times. SHM development, defined as a nonsynchronous SHM occurring ≥1 year after DCIS diagnosis, was our primary endpoint. Of 184,363 eligible patients with DCIS, 77,927 (42.3%) in the RT group, and 106,436 (57.7%) in the non-RT group, 1289 developed SHMs a median of 6.4 years (interquartile range, 3.5 to 10.3 years) after their DCIS diagnosis. Compared with DCIS patients in the non-RT group, RT was associated with increased early risk of developing acute lymphoblastic leukemia (ALL; hazard ratio, 3.15; 95% CI, 1.21 to 8.17; P = 0.02), and a delayed risk of non-Hodgkin lymphoma (NHL; hazard ratio, 1.33; 95% CI, 1.09 to 1.62; P < 0.001). This increased risk of ALL and NHL after RT was also observed in subgroup analyses restricted to low/intermediate-risk DCIS. In summary, our data suggest that RT after breast conserving surgery for DCIS patients should be cautiously tailored, especially for low and intermediate-risk patients. Long-term SHM surveillance after DCIS diagnosis is warranted. © 2021, The Author(s).

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大类 | 1 区

医学

小类 | 2 区肿瘤学

最新[2023]版：

大类 | 2 区医学

小类 | 2 区肿瘤学

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Q1 ONCOLOGY

最新[2023]版：

Q1 ONCOLOGY

影响因子： 6.6 最新[2023版] 6.6 最新五年平均 7.519 出版当年[2021版] 7.741 出版当年五年平均 6.923 出版前一年[2020版] 5.9 出版后一年[2022版]

第一作者：

第一作者机构： [1]Department of Endocrine and Breast Surgery, The First Affiliated hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China [2]Key Laboratory ofMolecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China [3]Department of Oncology-Pathology, Karolinska Institutet,Stockholm, Sweden

通讯作者：

通讯机构： [1]Department of Endocrine and Breast Surgery, The First Affiliated hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China [2]Key Laboratory ofMolecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China [3]Department of Oncology-Pathology, Karolinska Institutet,Stockholm, Sweden [11]Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden

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