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Prostate brachytherapy and second primary cancer risk: a competitive risk analysis
- Source :
- Journal of Clinical Oncology, 29, 4510-5, Journal of Clinical Oncology, 29, 34, pp. 4510-5
- Publication Year :
- 2011
-
Abstract
- Purpose To assess the risk of second primary cancer (SPC) after [125I]iodine prostate cancer brachytherapy compared with prostatectomy and the general population. Patients and Methods In a cohort consisting of 1,888 patients with prostate cancer who received monotherapy with brachytherapy (n = 1,187; 63%) or prostatectomy (n = 701; 37%), SPC incidences were retrieved by linkage with the Dutch Cancer Registry. Standardized incidence rates (SIRs) and absolute excess risks (AERs) were calculated for comparison. Results A total of 223 patients were diagnosed with SPC, 136 (11%) after brachytherapy and 87 (12%) after prostatectomy, with a median follow-up of 7.5 years. The SIR for all malignancies, bladder cancer, and rectal cancer were 0.94 (95% CI, 0.78 to 1.12), 1.69 (95% CI, 0.98 to 2.70), and 0.90 (95% CI, 0.41 to 1.72) for brachytherapy and 1.04 (95% CI, 0.83 to 2.28), 1.82 (95% CI, 0.87 to 3.35), and 1.50 (95% CI, 0.68 to 2.85) for prostatectomy, respectively. Bladder SPC risk was significantly increased after brachytherapy for patients age 60 years or younger (SIR, 5.84; 95% CI, 2.14 to 12.71; AER, 24.03) and in the first 4 years of follow-up (SIR, 2.14; 95% CI, 1.03 to 3.94; AER, 12.24). Adjusted for age, the hazard ratio (brachytherapy v prostatectomy) for all SPCs combined was 0.87 (95% CI, 0.64 to 1.18). Conclusion Overall, we found no difference in SPC incidence between patients with prostate cancer treated with prostatectomy or brachytherapy. Furthermore, no increased tumor incidence was found compared with the general population. We observed a higher than expected incidence of bladder SPC after brachytherapy in the first 4 years of follow-up, probably resulting from lead time or screening bias. Because of power limitations, a small increased SPC risk cannot be formally excluded.
- Subjects :
- Oncology
Male
Cancer Research
medicine.medical_specialty
Colorectal cancer
medicine.medical_treatment
Brachytherapy
Population
Aetiology, screening and detection [ONCOL 5]
Risk Assessment
Prostate cancer
Internal medicine
medicine
Humans
education
Aged
Prostatectomy
education.field_of_study
Bladder cancer
business.industry
Incidence
Prostatic Neoplasms
Neoplasms, Second Primary
Middle Aged
medicine.disease
Cancer registry
business
Prostate brachytherapy
Follow-Up Studies
SEER Program
Subjects
Details
- ISSN :
- 15277755 and 0732183X
- Volume :
- 29
- Issue :
- 34
- Database :
- OpenAIRE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....57f795ef99847a273aea2d87e2aaeffd