title: Prognostic factors and survival in patients with radiation-related second malignant neoplasms following radiotherapy for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases.
  
  
  METHODS
  Institutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included.
  
  
  RESULTS
  Median latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1-36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN.
  
  
  CONCLUSIONS
  Sex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Mian
authors.initials: M
authors.lastname: Xi
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Shi-Liang
authors.initials: SL
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China ; Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jing-Xian
authors.initials: JX
authors.lastname: Shen
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
authors.forename: Meng-Zhong
authors.initials: MZ
authors.lastname: Liu
mesh_terms: D000328:Adult; D002277:Carcinoma; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012737:Sex Factors; D016019:Survival Analysis