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Age-stratified associations between radiotherapy and SPMs for FPHNC: a population-based cohort study
Yuan-Yuan Li1,2, Qiong Liu3, Si-Qi Ying4,5
1State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University, Xi'an, 710032, China. yuanyuanli1@fmmu.edu.cn.
Radiotherapy increases the risk of second primary malignancies (SPMs) in head and neck cancer (HNC) survivors, with risks varying by age. Long-term surveillance is crucial for identifying and managing these radiation-associated cancers in HNC patients.
Area of Science:
- Oncology
- Radiation Oncology
- Epidemiology
Background:
- Second primary malignancies (SPMs) are a significant cause of mortality in head and neck cancer (HNC) patients, accounting for over 30% of deaths.
- The use of radiotherapy in HNC treatment raises concerns regarding an increased risk of radiation-associated SPMs.
- Understanding the age-specific risks of SPMs after radiotherapy is crucial for optimizing HNC patient management.
Purpose of the Study:
- To investigate the association between radiotherapy and the risk of SPMs in survivors of non-metastatic primary HNC.
- To analyze how this association varies across different age groups (young, middle-aged, elderly).
- To inform treatment decisions and surveillance strategies for HNC patients undergoing radiotherapy.
Main Methods:
- Utilized data from the Surveillance, Epidemiology, and End Results (SEER) program (2004-2015).
- Evaluated incidence rate ratios (IRRs) and standardized incidence ratios (SIRs) for solid and hematologic SPMs in radiotherapy-exposed versus unexposed HNC survivors.
- Employed multivariable modified Poisson regression and compared observed to expected cancer rates in the general population, with age-stratified analyses.
Main Results:
- Radiotherapy was associated with an increased risk of solid SPMs (IRR=1.16).
- The risk varied significantly by age: increased solid SPM risk in middle-aged patients (IRR=1.21) and decreased hematologic SPM risk in elderly patients (IRR=0.77).
- Young patients showed a high risk for radiotherapy-associated non-Hodgkin lymphoma (SIR=4.01), middle-aged patients for bone/joint SPMs (SIR=7.72), and elderly patients for esophageal SPMs (SIR=3.87).
Conclusions:
- An age-stratified association exists between radiotherapy and SPM risk in HNC patients.
- Patient age is a critical factor in treatment decisions for HNC.
- Long-term surveillance is recommended for HNC survivors, particularly those in high-risk age groups, to monitor for SPMs.
