title: Second primary cancers in patients with stage III non-small cell lung cancer successfully treated with chemo-radiotherapy.
abstract: BACKGROUND
  Patients successfully treated for non-small cell lung cancer (NSCLC) remain at risk for developing second primary cancer (SPC). The purpose of the current study is to assess the incidence of SPC and the impact of smoking status on the SPC in long-term survivors with stage III NSCLC after chemo-radiotherapy.
  
  
  METHODS
  Using the database from the Japan National Hospital Lung Cancer Study Group between 1985 and 1995, information was obtained on 62 patients who were more than 3 years disease-free survivors. Details of clinical information and most smoking history were available from the questionnaire.
  
  
  RESULTS
  Nine of the 62 patients developed SPC 3.9-12.2 years (median, 6.2 years) after the initiation of the treatment. The site of SPC was 2 lung, 1 esophagus, 2 stomach, 1 colon, 1 breast, 1 skin and 1 leukemia. Among these nine, three cancers occurred inside the radiation field. The relative risk of any SPC was 2.8 [95% confidence interval (CI) 1.3-5.3]. The risk changed with the passage of time and it increased significantly (5.2 times at or beyond 7 years) after the treatment. In univariate analysis, the patients who were male, had more cumulative smoking and continued smoking, had an increased risk of SPC [relative risk (RR) 2.7, CI 1.1-5.3; RR 3.0, CI 1.2-6.2; RR 5.2, CI 1.6-11.7, respectively]. In multivariate analysis, factors including smoking status and histological type had no effect on the development of a SPC.
  
  
  CONCLUSIONS
  The patients with stage III NSCLC successfully treated with chemo-radiotherapy were at risk for developing SPC and this risk increased with time.
authors.affiliation: National Hospital Study Group for Lung Cancer in Japan. t-kawaguchi@kch.hosp.go.jp
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Akihide
authors.initials: A
authors.lastname: Matsumura
authors.forename: Keiji
authors.initials: K
authors.lastname: Iuchi
authors.forename: Seiji
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Shimao
authors.initials: S
authors.lastname: Fukai
authors.forename: Hikotaro
authors.initials: H
authors.lastname: Komatsu
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D011879:Radiotherapy Dosage; D012306:Risk; D012907:Smoking / Q000009:adverse effects*