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Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer.

Publication ,  Journal Article
Xie, L; Bao, X; Cai, T; Silva, SG; Ma, J; Zhang, Z; Guo, X; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
October 1, 2019

PURPOSE: To estimate the effect of radiation therapy (RT) on nonbreast second malignant neoplasms (SMNs) in young women survivors of stage I-IIIA breast cancer. METHODS AND MATERIALS: Women aged 20 to 44 years who received a diagnosis of stage I-IIIA breast cancer (1988-2008) were identified in the Surveillance, Epidemiology, and End Results 9 registries. Bootstrapping approach and competing-risk proportional hazards models were used to evaluate the effect of RT on nonbreast SMN risk. The analysis was repeated in racial subgroups. Radiotolerance score analysis of normal airway epithelium was performed using Gene Expression Omnibus (GEO) data sets. RESULTS: Within records of 30,003 women with primary breast cancer, 20,516 eligible patients were identified, including 2,183 African Americans (AAs) and 16,009 Caucasians. The 25-year cumulative incidences of SMN were 5.2% and 3.6% (RT vs no-RT) for AAs, with 12.8-year and 17.4-year (RT vs no-RT) median follow-up (hazard ratio [HR] = 1.81; 95% bootstrapping confidence interval [BCI], 1.02-2.50; P < .05), respectively, and 6.4% and 5.9% (RT vs no-RT) for Caucasians with 14.3-year and 18.1-year (RT vs no-RT) median follow-up (HR = 1.10; 95% BCI, 0.61-1.40; P > .05), respectively. The largest portion of excess RT-related SMN risk was lung cancer (AA: HR = 2.08, 95% BCI, 1.02-5.39, P < .05; Caucasian: HR = 1.50, 95% BCI, 0.84-5.38, P > .05). Subpopulation Treatment Effect Pattern Plot (STEPP) analysis revealed higher post-RT nonbreast SMN risk in those 20 to 44 years of age, with larger HRs for RT in AAs. Radiotolerance score (RTS) of normal airway epithelium from young AA women was significantly lower than that from young Caucasian women (P = .038). CONCLUSIONS: With a projected 25-year follow-up, RT is associated with elevated risk of nonbreast SMNs, particularly second lung cancer, in young women survivors of stage I-IIIA breast cancer. Nonbreast SMNs associated with RT are higher in AA women than Caucasian women.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

October 1, 2019

Volume

105

Issue

2

Start / End Page

275 / 284

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Statistics, Nonparametric
  • SEER Program
  • Radiation Tolerance
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms, Radiation-Induced
 

Citation

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Xie, L., Bao, X., Cai, T., Silva, S. G., Ma, J., Zhang, Z., … Marks, L. B. (2019). Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer. Int J Radiat Oncol Biol Phys, 105(2), 275–284. https://doi.org/10.1016/j.ijrobp.2019.06.010
Xie, Liyi, Xuhui Bao, Tianji Cai, Susan G. Silva, Jinli Ma, Zhen Zhang, Xiaomao Guo, and Lawrence B. Marks. “Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer.Int J Radiat Oncol Biol Phys 105, no. 2 (October 1, 2019): 275–84. https://doi.org/10.1016/j.ijrobp.2019.06.010.
Xie L, Bao X, Cai T, Silva SG, Ma J, Zhang Z, et al. Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer. Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):275–84.
Xie, Liyi, et al. “Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer.Int J Radiat Oncol Biol Phys, vol. 105, no. 2, Oct. 2019, pp. 275–84. Pubmed, doi:10.1016/j.ijrobp.2019.06.010.
Xie L, Bao X, Cai T, Silva SG, Ma J, Zhang Z, Guo X, Marks LB. Elevated Risk of Radiation Therapy-Associated Second Malignant Neoplasms in Young African-American Women Survivors of Stage I-IIIA Breast Cancer. Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):275–284.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

October 1, 2019

Volume

105

Issue

2

Start / End Page

275 / 284

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Statistics, Nonparametric
  • SEER Program
  • Radiation Tolerance
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms, Radiation-Induced