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Secondary Cancer in Prostate Cancer Patients Treated With Advanced External Beam Radiation Therapy.

Sarah E Kulkarni1, Sagar A Patel2, Yuxian Sun1

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Proton beam therapy (PBT) and stereotactic body radiation therapy (SBRT) show lower second primary cancer risk in prostate cancer patients compared to intensity-modulated radiation therapy (IMRT). These advanced radiation techniques offer a safer treatment option.

Keywords:
Localized prostate cancerProton beam therapyRadiation therapySecondary tumorStereotactic body radiation therapy

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Cancer Epidemiology

Background:

  • External beam radiation therapy is linked to increased second primary cancer (SPC) risk in prostate cancer (PCa) patients.
  • The comparative SPC risk of advanced radiation modalities like proton beam therapy (PBT) and stereotactic body radiation therapy (SBRT) versus intensity-modulated radiation therapy (IMRT) remains unclear.

Purpose of the Study:

  • To assess the relative probability of SPC among PCa patients treated with PBT and SBRT compared to IMRT.
  • Evaluate the safety and efficacy of newer radiation techniques in reducing secondary cancer risk.

Main Methods:

  • Utilized the National Cancer Database (NCDB) to identify N0M0 PCa cases diagnosed between 2004 and 2018.
  • Compared SPC probabilities among patients receiving curative-intent PBT, SBRT, and IMRT.
  • Employed multivariable logistic regression and inverse probability of treatment weighting (IPTW) for adjusted analyses.

Main Results:

  • A total of 133,898 patients were analyzed (PBT: 2.6%, IMRT: 90.5%, SBRT: 6.9%).
  • PBT and SBRT were associated with significantly lower SPC risk compared to IMRT (PBT aOR: 0.49, SBRT aOR: 0.57; P < .001).
  • IPTW analyses confirmed the reduced SPC risk for PBT and SBRT.

Conclusions:

  • In a large national cohort, PBT and SBRT demonstrated similar outcomes regarding SPC risk.
  • Both PBT and SBRT are associated with reduced SPC risk compared to IMRT as a first-line treatment for prostate cancer.
  • These findings support the use of PBT and SBRT for potentially improving long-term outcomes in prostate cancer patients.