title: Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study.
abstract: To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients.
  
  
  
  We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery.
  
  
  
  Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR = 1.66, 95% CI: 1.09-2.54).
  
  
  
  Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions. Prostate 77:437-445, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.|Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Huntington
authors.affiliation: Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.|Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.|Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, Connecticut.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Ma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D007953:Leukemia, Radiation-Induced / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acute myeloid leukemia; myelodysplastic syndromes; prostate cancer; radiotherapy; second cancer