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Radiotherapy of prostate cancer: impact of treatment characteristics on the incidence of second tumors

  • BUWENGE, Milly1
  • SCIROCCO, Erica1
  • DEODATO, Francesco2
  • MACCHIA, Gabriella2
  • NTRETA, Maria1
  • BISELLO, Silvia1
  • SIEPE, Giambattista1
  • CILLA, Savino2
  • ALITTO, Anna Rita3
  • VALENTINI, Vincenzo3, 4
  • STRIGARI, Lidia5
  • MORGANTI, Alessio G.1
  • CAMMELLI, Silvia1
  • 1 University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, Bologna, 40138, Italy , Bologna (Italy)
  • 2 Catholic University of Sacred Heart, Campobasso, Italy , Campobasso (Italy)
  • 3 Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy , Rome (Italy)
  • 4 Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy , Rome (Italy)
  • 5 Medical Physics Unit, “S. Orsola-Malpighi” Hospital, Bologna, Italy , Bologna (Italy)
Published Article
BMC Cancer
Springer (Biomed Central Ltd.)
Publication Date
Feb 03, 2020
DOI: 10.1186/s12885-020-6581-5
Springer Nature


BackgroundIt has been hypothesized that radiotherapy (RT) techniques delivering radiations to larger volumes (IMRT, VMAT) are potentially associated with a higher risk of second primary tumors. The aim of this study was to analyse the impact of RT technique (3D-CRT vs IMRT/VMAT) on the incidence of second tumors in prostate cancer (PCa) patients.MethodsA retrospective study on 2526 previously irradiated PCa patients was performed. Patients were treated with 3D-CRT (21.3%), IMRT (68.1%), or VMAT (10.6%). Second tumors incidence was analysed in 3 categories: pelvic, pelvic and abdominal, and “any site”. The correlation with RT technique was analysed using log-rank test and Cox’s proportional hazard method.ResultsWith a median follow-up of 72 months (range: 9–185), 92 (3.6%) cases of second tumors were recorded with 48 months (range: 9–152) median interval from RT. Actuarial 10-year second tumor free survival (STFS) was 87.3%. Ten-year STFS in patients treated with 3D-CRT and IMRT/VMAT was 85.8 and 84.5%, respectively (p: .627). A significantly higher 10-year cumulative incidence of second tumors in the pelvis was registered in patients treated with IMRT/VMAT compared to 3D-CRT (10.7% vs 6.0%; p: .033). The lower incidence of second pelvic cancers in patients treated with 3D-CRT was confirmed at multivariable analysis (HR: 2.42, 95%CI: 1.07–5.47, p: .034).ConclusionsThe incidence of second pelvic tumors after RT of PCa showed a significant correlation with treatment technique. Further analyses in larger series with prolonged follow-up are needed to confirm these results.

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