• Eur. J. Cancer · Jan 2020

    Increased risk for second primary rectal cancer after pelvic radiation therapy.

    • RomboutsAnouk J MAJMDepartment of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: anouk.rombouts@radboudumc.nl., Niek Hugen, Marloes A G Elferink, PoortmansPhilip M PPMPDepartment of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Radiation Oncology, Institut Curie & Paris Sciences & Lettres - PSL University, Paris, France., Iris D Nagtegaal, and de WiltJohannes H WJHWDepartment of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands..
    • Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: anouk.rombouts@radboudumc.nl.
    • Eur. J. Cancer. 2020 Jan 1; 124: 142-151.

    BackgroundThe 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.MethodsData 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.ResultsA 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).ConclusionsPatients 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.Copyright © 2019 Elsevier Ltd. All rights reserved.

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