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Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij radiotherapie - bestraling van arts-bioloog drs. Engelbert Valstar

20 januari 2021: Bron: JAMA 8th. of january 2021

Bestraling - radiotherapie als onderdeel van een behandeling van vrouwen met endeldarmkanker - rectumkanker blijkt het risico op een tweede vorm van primaire kanker behoorlijk groter te maken dan bij vrouwen die geen bestraling - radiotherapie hebben ondergaan. Een tweede gynaecologische vorm van kanker (met name eierstokkanker, endometriosekanker en baarmoederkanker en baarmoederhalskanker) werd opgemerkt bij 2,7% van de patiënten die radiotherapie hadden gekregen na een periode van 5 jaar over een studieperiode van dertig jaar totaal.

De cumulatieve incidentie van secundaire gynaecologische maligniteit was 2,16% na een diagnose van endeldarmkanker, met een incidentie van 1,53% bij patiënten die geen radiotherapie kregen versus 4,53% bij patiënten die dat wel deden (P <.001) 
De onderzoekers pleiten dan ook voor een zorgvuldige controle op secundaire vormen van kanker bij die patiënten die voor hun endeldarmkanker - rectumkanker zijn bestraald.

Dubbele primaire vormen van kanker (zie bv deze studie: Multiple primary tumors: a case report and review of the literature):  

In Azië worden kankerpatiënten vaak gescreend op dubbele primaire kanker wanneer er bij de eerste diagnose kanker in het bekkengebied en buik wordt geconstateerd met al uitzaaiingen. Het komt zelfs voor dat bij 1 persoon drie of vier verschillende vormen van verschillende kanker wordt gezien. Meerdere primaire tumoren worden gedefinieerd als meer dan één synchrone (binnen 6 maanden) of metachrone tumoren bij hetzelfde individu worden geconstateerd. [7]. 

  • Synchrone metastasen zijn metastasen die ontdekt zijn bij de diagnose van de primaire tumor.
  • Metachrone metastasen zijn metastasen die ontstaan zijn enkele maanden na de diagnose van de primaire tumor.


Longhi et al. [8] hebben ontdekt dat tweede primaire vormen van kanker vaak behandelingsgerelateerde ziekten zijn, die binnen 10 jaar bij 3,6% van de overlevenden van het botsarcoom voorkomen. De meest voorkomende vormen van tweede kanker zijn onder meer borstkankerleukemiesarcomen en speekselklierneoplasmes. 

Zie Salivary gland second cancer after bone sarcoma treatment


De definities van meerdere primaire tumoren verschillen van onderzoek tot onderzoek. Het kan worden bevestigd of tumoren op verschillende plaatsen ontstaan ​​en / of een andere histologie hebben. Bovendien moet worden uitgesloten dat de ene laesie een uitzaaiing is van een andere, of van een tweede vorm van primaire kanker.

In JAMA is het studierapport van deze retrospectieve analyse gratis in te zien: 

Association of Radiotherapy for Rectal Cancer and Second Gynecological Malignant Neoplasms

Key Points

Question  Is radiotherapy for rectal cancer associated with the increasing risk of second gynecological malignant neoplasms and prognosis in women with rectal cancer?

Findings  In this cohort study of 20 142 patients with rectal cancer, radiotherapy for rectal cancer was associated with an increased risk of second cancer of the uterine corpus and ovarian cancer. Development of cancer of the uterine corpus was associated with a worse prognosis.

Meaning  Results of this study suggest that special attention is warranted to reduce the risk of second gynecological malignant neoplasms in the treatment and follow-up of patients with rectal cancer after radiotherapy.

Abstract

Importance  Radiotherapy is a common treatment for rectal cancer, yet the risk of second gynecological malignant neoplasms (SGMNs) in patients with rectal cancer undergoing radiotherapy have not been adequately studied.

Objective  To investigate the association between radiotherapy and the risk of individual types of SGMN in patients with rectal cancer and assess survival outcomes.

Design, Setting, and Participants  A large population-based cohort study was designed to identify the risk of SGMNs in patients with rectal cancer diagnosed from January 1973 to December 2015. The statistical analysis was conducted from September 2019 to April 2020. The study was based on the 9 cancer registries of Surveillance, Epidemiology, and End Results database. A total of 20 142 female patients with rectal cancer in localized and regional stage were included.

Exposure  Receipt of neoadjuvant radiotherapy for rectal cancer.

Main Outcomes and Measures  The development of an SGMN defined as any type of GMN occurring more than 5 years after the diagnosis of rectal cancer. The cumulative incidence of SGMNs was estimated by Fine-Gray competing risk regression. Poisson regression was used to evaluate the radiotherapy-associated risk for SGMNs in patients undergoing radiotherapy vs patients not undergoing radiotherapy. The Kaplan-Meier method was used to assess the survival outcomes of patients with SGMNs.

Results  Of 20 142 patients, 16 802 patients (83.4%) were White and the median age was 65 years (interquartile range, 54-74 years). A total of 5310 (34.3%) patients were treated with surgery and radiotherapy, and 14 832 (65.7%) patients were treated with surgery alone. The cumulative incidence of SGMNs during 30 years of follow-up was 4.53% among patients who received radiotherapy and 1.53% among patients who did not. In competing risk regression analysis, undergoing radiotherapy was associated with a higher risk of developing cancer of the uterine corpus (adjusted hazard ratio, 3.06; 95% CI, 2.14-4.37; P < .001) and ovarian cancer (adjusted hazard ratio, 2.08; 95% CI, 1.22-3.56; P = .007) compared with those who did not receive radiotherapy. The dynamic radiotherapy-associated risks (RR) for cancer of the uterine corpus significantly increased with increasing age at rectal cancer diagnosis (aged 20-49 years: adjusted RR, 0.79; 95% CI, 0.35-1.79; P = .57; aged 50-69 years: adjusted RR, 3.74; 95% CI, 2.63-5.32; P < .001; aged ≥70 years: adjusted RR, 5.13; 95% CI, 2.64-9.97; P < .001) and decreased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 3.22; 95% CI, 2.12-4.87; P < .001; 120-239 months: adjusted RR, 2.72; 95% CI, 1.75-4.24; P < .001; 240-360 months: adjusted RR, 1.95; 95% CI, 0.67-5.66; P = .22), but the dynamic RR for ovarian cancer increased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 0.70; 95% CI, 0.26-1.89; P = .48; 120-239 months: adjusted RR, 2.26; 95% CI, 1.09-4.70; P = .03; 240-360 months: adjusted RR, 11.84; 95% CI, 2.18-64.33; P = .004). The 10-year overall survival among patients with radiotherapy-associated cancer of the uterine corpus was significantly lower than that among matched patients with primary cancer of the uterine corpus (21.5% vs 33.6%; P = .01).

Conclusions and Relevance  Radiotherapy for rectal cancer was associated with an increased risk of cancer of the uterine corpus and ovarian cancer. Special attention should be paid to reduce radiotherapy-associated SGMNs and improve their prognosis.

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