Long-term survival and risk of second cancers after radiotherapy for cervical cancer.
OBJECTIVE
To evaluate the risk of second cancers after cervical cancer treated with radiotherapy for Asian populations.


METHODS
We reviewed 2,167 patients with cervical cancer undergoing radiotherapy between 1961 and 1986. Intracavitary brachytherapy was performed with high-dose rate source (82%) or low-dose rate source (12%). Relative risk (RR), absolute excess risk (AR), and cumulative risk of second cancer were calculated using the Japanese disease expectancy table. For 1,031 patients, the impact of smoking habit on the increasing risk of second cancer was also evaluated.


RESULTS
The total number of person-years of follow-up was 25,771, with 60 patients being lost to follow-up. Among the 2,167 patients, 1,063 (49%) survived more than 10 years. Second cancers were observed in 210 patients, representing a significant 1.2-fold risk (95% confidence interval [CI], 1.1-1.4) of developing second cancer compared with the general population, 1.6% excess risk per person per decade of follow-up, and elevating cumulative risk up to 23.8% (95% CI, 20.3-27.3) at 30 years after radiotherapy. The RR of second cancer was 1.6-fold for patients with the smoking habit and 1.4-fold for those without.


CONCLUSIONS
Small but significant increased risk of second cancer was observed among Japanese women with cervical cancer mainly treated with high-dose rate brachytherapy. Considering the fact that about half of the patients survived more than 10 years, the benefit of radiotherapy outweighs the risk of developing second cancer.
Ohno
Tatsuya
T
Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan. t_ohno@nirs.go.jp
Kato
Shingo
S
Sato
Shinichiro
S
Fukuhisa
Kenjiro
K
Nakano
Takashi
T
Tsujii
Hirohiko
H
Arai
Tatsuo
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D011879:Radiotherapy Dosage; D012306:Risk; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000401:mortality / Q000532:radiotherapy*