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Impact of Advanced External Beam Radiotherapy on Second Haematological Cancer Risk in Prostate Cancer Survivors.

M-C Jahreiß1, W D Heemsbergen1, C Janus1

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Clinical Oncology (Royal College of Radiologists (Great Britain))
|February 1, 2023
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Summary

External beam radiotherapy (EBRT) for prostate cancer (PCa) increases the risk of second hematological cancers (SHC). While risks were elevated across all EBRT eras, they were highest in earlier treatment periods.

Keywords:
Intensity-modulated radiotherapyprostate cancersecond haematological cancersurvivorshipthree-dimensional conformal radiotherapyvolumetric modulated arc therapy

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Area of Science:

  • Oncology
  • Radiotherapy
  • Epidemiology

Background:

  • External beam radiotherapy (EBRT) for prostate cancer (PCa) has evolved with advanced techniques.
  • Altered dose distributions in modern EBRT may influence the risk of second hematological cancers (SHC).

Purpose of the Study:

  • To assess the risk of SHC following EBRT for PCa.
  • To determine if SHC risk has changed over different EBRT eras.

Main Methods:

  • A cohort of T1-T3 PCa patients treated between 1990-2015 was analyzed using the Netherlands Cancer Registry.
  • Patients were categorized into EBRT eras: 2D-RT, 3D-CRT, and advanced EBRT.
  • Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated; relative risks (sHR) compared EBRT to radical prostatectomy and active surveillance.

Main Results:

  • PCa patients receiving EBRT showed an increased SHC risk (SIR=1.20) compared to the general Dutch male population.
  • The highest risk was observed in the 2D-RT era (SIR=1.32), with lower risks in 3D-CRT (SIR=1.16) and advanced EBRT (SIR=1.21) eras.
  • Absolute excess risks were minimal; EBRT showed a significant increased risk versus active surveillance (sHR=1.17) but not radical prostatectomy (sHR=1.08).

Conclusions:

  • Elevated SHC risks were noted for all EBRT eras compared to the general population.
  • Excess risks were primarily observed when comparing EBRT to active surveillance for PCa treatment.