A good study on "secondary cancers"

A lot of good info here, including secondary cancers after radiation treatments

http://www.ncbi.nlm.nih.gov/books/NBK20948/

David

 

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I agree, it's not a specific tie-in per say. But its in line with what my former oncologist from my porocarcinoma days (2000), my more recent RO, and my current oncologist have warned.

And while it often takes many years to develop, that is not always the case.

My point, is that all men should be aware, that there is a risk of secondary cancers developing as the results of undergoing any form of RT, whether it be a primary usage, or as a salvage or secondary use.

The risk is there. My doctor strongly feels, that the typical RO (not all), understates the general risk of radiation in general, both with short and long term side effects, as well as the presumed risk of developing secondary cancers in the future.

It doesn't mean or imply that RT shouldn't be used, for many patients, it's a very effective treatment tool, but it should be used wisely, when really needed, and with the best means of delivery as possible.

In my case, I had a total of 142 gys delievered in just a nine year period, and that doesn't count the radiation count of dozens of scans and even more from conventional x-rays. And half of that 142 was delivered "old school", non-guided, so it did a lot of collateral damage at the time, then the other half, well we know what happened to me in 2009 from the SRT event.

One reason my doctor is so touchy about me having any type of scan that involves radiation.

Right now, all I can think about, is hoping and praying there is nothing sinister going on in my kidneys.

David

I agree with Sephie. The best data I've seen about secondary cancers associated with treatment for prostate cancer was the Memorial Sloan Kettering study a couple of years ago. They showed that the ten year risk of secondary pelvic (bladder and rectal) cancers ranged from 2-4% no matter whether the man had radiation or surgery. Furthermore, they found that any increased risk of secondary cancers was entirely explained by age and smoking, and not by whether or not they had radiation.

Others have estimated that odds of radiation-induced cancers for any type of cancer is less than 5 in a thousand. Of course, there will always be the one in a million cases of people who lack the ability to repair radiation damage to healthy tissues, such as occurs with mutations to the ATM gene.

A problem inherent in all long term studies is that by the time we have the data, the treatment has changed. Possibly, highly conformal IMRT, more accurate IGRT techniques, and hypofractionation may have further reduced any risks. Perhaps more importantly, they have reduced urinary and rectal SEs.

- Allen

Thank you, Tall Allen, for posting that study. Since there are so many lurkers on Healingwell, it is so important that you remind everyone that the actual harm of radiation is so low, although there are some regulars who have been seriously affected by their radiation treatments. The study was interesting because it said that a "history of smoking" is an important variable in the incidence of secondary malignancies and also that these secondary malignancies do not affect mortality. I wonder if anyone has done studies to see what is meant by history: recent cessation, still smoking, long term smoker but quit years ago, etc.
Your story, Greetingz is important and your outlook commendable. There are such serious cases here of prostate cancer and we are all affected by your story. My best to you.
It is very difficult to read about the stress that constant worrying about bladder, rectal, pancreatic, lung or kidney secondary malignancies causes, especially when testing to see if there is any prostate cancer progression is infrequent. It's too bad there isn't another answer. Have any of the doctors checked to see if the side effects of something so simple as long term Ambien use can cause any of the symptoms?

A more recent study - published in The Lancet Oncology, Jan 17, 2014

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2813%2970606-5/fulltext

"Seems like some here don't agree to the risk of secondary cancers in relation to prior radiation. It's a very well supported and known risk, and I believe it's understated on purpose by some RO's to sell their goods to the patient. They are famous for doing their thing, damage or no damage, and quickly handing off the patient back to the urologist or oncologist with problems at hand. Both my doctors say this happens all the time. That RO's never want to take responsibility to the damage they cause"

I don't have the full article yet but the summary said that this recent Canadian study actually showed radiation treatments had more complications including secondary cancers:

Findings
In the 32 465 patients included in the study, the 5-year cumulative incidence of admission to hospital for a treatment-related complication was 22·2% (95% CI 21·7—22·7), but was 2·4% (2·2—2·6) for patients whose length of stay was longer than 1 day. The 5-year cumulative incidence of needing a urological procedure was 32·0% (95% CI 31·4—32·5), that of a rectal or anal procedure was 13·7% (13·3—14·1), and that of an open surgical procedure was 0·9% (0·8—1·1). The 5-year cumulative incidence of a second primary malignancy was 3·0% (2·6—3·5). These risks were significantly higher than were those of 32 465 matched controls with no history of prostate cancer. Older age and comorbidity at the time of index treatment were important predictors for a complication in all outcome categories, but the type of treatment received was the strongest predictor for complications. Patients who were given radiotherapy had higher incidence of complications for hospital admissions, rectal or anal procedures, open surgical procedures, and secondary malignancies at 5 years than did those who underwent surgery (adjusted hazard ratios 2·08—10·8, p<0·0001). However, the number of urological procedures was lower in the radiotherapy than in the surgery group (adjusted hazard ratio 0·66, 95% CI 0·63—0·69; p<0·0001)

I have been looking at secondary cancer data for a while now and agree with Allen. Most of these studies were in the age of older non-conformal ERBT treatments and there was a risk in secondary bladder and rectal cancers. All of the studies that reflect the newer IMRT or BT treatments show no such relationship. Up until 10 years ago older patients were also routed to radiation rather than surgery resulting in a higher risk selection group.
If you look at the more recent data reflecting the newer radiation treatments and adjust for age there is little difference among surgery patients and radiation patients.

David,

I finally got hold of the full article and took a quick look. It was a retrospective population study with a large population, 32,465 patients were treated between 2002 and 2009 about half of the population were treated with radiation and the other half were surgery. They did a multivariate statistical study to eliminate other factors. They compared the outcome within each group and with a controlled general population that did not have prostate cancer. The outcome that is relevant to this discussion is as follows:

1. They looked for secondary cancer 5-9 years after treatment, matched and compared patients with the general population with the same background.

2. They used data from modern radiation practices (2002 to 2009) - Full 3-D treatment planning including the development of a dose volume histogram.

3. For the age group between 40 and 65, the risks of secondary cancer for those treated with radiation were 3.5 times higher than the general population matched pairs. For surgery, the risks were slightly higher but about the same as the general population.

4. For older patients, those between 65 and 90, the risks of secondary cancer were actually slightly lower than the general population. For surgery patients of this age group, the risks of secondary cancer were also lower.

They matched age group so the argument that radiation patients are older and therefore more prong to cancer did not apply. Also, a 3.5 times higher risks with such a large sample size is statistically significant vs most other studies using much smaller sample sizes.

Thanks for the article, Purg. Secondary cancers are indeed a concern though it isn't something that happens too often thank goodness.

Paul's PCa was believed to have been a secondary cancer. The biopsied tissue "resembled radiated tissue."
Though both the local pathologist and Epstein were of the same opinion they said there was no absolute way to prove it.

When he was diagnosed with TCa, Paul was given a choice of radiation or chemo after surgery to remove the tumor. Chemo also carries immediate and long term risks so he went with the treatment that he felt most comfortable in choosing. When deciding on treatment for PCa, radiation wasn't an option because he had already had his lifetime limit. At least it made his decision less complicated.

If there was an upside to the diagnosis; in a way, I was relieved. Paul was considered pretty young for PCa. If it is indeed a secondary cancer, our son is not at a higher risk for than average.

Swim