Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605840
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Associations between radiotherapy and causes of death as potential late side effects in a German breast cancer cohort

N Obi
1   Universitätsklinikum Hamburg-Eppendorf, Inst. f. Medizinische Biometrie & Epidemiologie, Hamburg
,
C zu Eulenburg
1   Universitätsklinikum Hamburg-Eppendorf, Inst. f. Medizinische Biometrie & Epidemiologie, Hamburg
2   University of Groningen, Medical Statistics and Decision Making, Groningen
,
P Seibold
3   German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg
,
U Eilber
3   German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg
,
K Thöne
4   University Medical Center Hamburg-Eppendorf, Department of Cancer Epidemiology/Clinical Cancer Registry, Hamburg
,
S Behrens
3   German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg
,
J Chang-Claude
3   German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg
5   University Medical Center Hamburg-Eppendorf, Genetic Tumor Epidemiology Group, Hamburg
,
D Flesch-Janys
1   Universitätsklinikum Hamburg-Eppendorf, Inst. f. Medizinische Biometrie & Epidemiologie, Hamburg
4   University Medical Center Hamburg-Eppendorf, Department of Cancer Epidemiology/Clinical Cancer Registry, Hamburg
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2017 (online)

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Background:

Studies of cohorts of breast cancer (BC) patients diagnosed before 1990 showed radiotherapy (RT) to be associated with increased cardiovascular (CVD) and lung cancer mortality up to the third decade after diagnosis. In the late 1990 s, improvements in RT planning techniques reduced radiation doses to normal tissues. Recent studies did not consistently report higher RT-related mortality for CVD and second cancers. Aim of the present study was to analyze specific causes of death after 3D-conformal RT in a BC cohort.

Methods:

Patients with stage I-III BC diagnosed 2001 to 2005 enrolled in the population based MARIE study were followed up to June 30, 2015 (median 11.9 years, range 0.3 – 13.5). Causes of death were extracted from death certificates and coded according to ICD-10. Associations between adjuvant RT and cause specific mortality were analyzed by using Fine-Gray competing risks models adjusted for differences in baseline characteristics applying inverse-probability-of-treatment-weighting (IPTW).

Results:

Of the 2951 patients, 83.0% received adjuvant RT. No significant association of RT with lung cancer mortality (subdistribution hazard ratio, SHR IPTW 0.88, 0.35 – 2.12), with other cancer mortality (SHR IPTW 1.04, 95% CI 0.62 – 1.73) or cardiac mortality was observed (SHR IPTW 1.57, 0.75 – 3.29). Mortality from lung- and other diseases were significantly lower in irradiated compared to non-irradiated women (SHR IPTW 0.39, 95% CI 0.17 – 0.90 and SHR IPTW 0.58, 95% CI 0.34 – 0.97, respectively).

Discussion:

Modern RT did not significantly increase mortality from other causes than BC in the German MARIEplus cohort. In line with recent studies, earlier evidence of RT-related elevated cardiac mortality became ambiguous, probably attributable to improved radiation techniques and shorter follow-up times. Since long-term data are still sparse, existing cohorts, which received modern RT, should be monitored through the next decade.