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Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation
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 increa...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925676/ https://www.ncbi.nlm.nih.gov/pubmed/33654083 http://dx.doi.org/10.1038/s41523-021-00228-6 |
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author | Wang, Kang Li, Zhuyue Chen, Xingxing Zhang, Jianjun Xiong, Yongfu Zhong, Guochao Shi, Yang Li, Qing Zhang, Xiang Li, Hongyuan Xiang, Tingxiu Foukakis, Theodoros Radivoyevitch, Tomas Ren, Guosheng |
author_facet | Wang, Kang Li, Zhuyue Chen, Xingxing Zhang, Jianjun Xiong, Yongfu Zhong, Guochao Shi, Yang Li, Qing Zhang, Xiang Li, Hongyuan Xiang, Tingxiu Foukakis, Theodoros Radivoyevitch, Tomas Ren, Guosheng |
author_sort | Wang, Kang |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7925676 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-79256762021-03-19 Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation Wang, Kang Li, Zhuyue Chen, Xingxing Zhang, Jianjun Xiong, Yongfu Zhong, Guochao Shi, Yang Li, Qing Zhang, Xiang Li, Hongyuan Xiang, Tingxiu Foukakis, Theodoros Radivoyevitch, Tomas Ren, Guosheng NPJ Breast Cancer Article 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. Nature Publishing Group UK 2021-03-02 /pmc/articles/PMC7925676/ /pubmed/33654083 http://dx.doi.org/10.1038/s41523-021-00228-6 Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Wang, Kang Li, Zhuyue Chen, Xingxing Zhang, Jianjun Xiong, Yongfu Zhong, Guochao Shi, Yang Li, Qing Zhang, Xiang Li, Hongyuan Xiang, Tingxiu Foukakis, Theodoros Radivoyevitch, Tomas Ren, Guosheng Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title | Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title_full | Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title_fullStr | Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title_full_unstemmed | Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title_short | Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
title_sort | risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925676/ https://www.ncbi.nlm.nih.gov/pubmed/33654083 http://dx.doi.org/10.1038/s41523-021-00228-6 |
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