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[Abstract]

PURPOSE: This study investigated the long-term probability of developing a second cancer in a large pooled cohort of patients treated with surgery with or without radiotherapy (RT).

PATIENTS AND METHODS: All second cancers diagnosed in patients included in the TME, PORTEC-1, and PORTEC-2 trials were analyzed. In the TME trial, patients with rectal cancer (n = 1,530) were randomly allocated to preoperative external-beam RT (EBRT; 25 Gy in five fractions) or no RT. In the PORTEC trials, patients with endometrial cancer were randomly assigned to postoperative EBRT (46 Gy in 2-Gy fractions) versus no RT (PORTEC-1; n = 714) or EBRT versus vaginal brachytherapy (VBT; PORTEC-2; n = 427).

RESULTS: A total of 2,554 patients were analyzed (median follow-up, 13.0 years; range 1.8 to 21.2 years). No differences were found in second cancer probability between patients who were treated without RT (10- and 15-year rates, 15.8% and 26.5%, respectively) and those treated with EBRT (10- and 15-year rates, 15.4% and 25.6%, respectively) or VBT (10-year rate, 14.9%). In the individual trials, no significant differences were found between treatment arms. All cancer survivors had a higher risk of developing a second cancer compared with an age- and sex-matched general population. The standardized incidence ratio for any second cancer was 2.98 (95% CI, 2.82 to 3.14).

CONCLUSION: In this pooled trial cohort of > 2,500 patients with pelvic cancers, those who underwent EBRT or VBT had no higher probability of developing a second cancer than patients who were treated with surgery alone. However, patients with rectal or endometrial cancer had an increased probability of developing a second cancer compared with the general population.

© 2014 by American Society of Clinical Oncology.

​[Author information]

​Wiltink LM1, Nout RA1, Fiocco M1, Meershoek-Klein Kranenbarg E1, Jürgenliemk-Schulz IM1, Jobsen JJ1, Nagtegaal ID1, Rutten HJ1, van de Velde CJ1, Creutzberg CL1, Marijnen CA2.​

1 Lisette M. Wiltink, Remi A. Nout, Marta Fiocco, Elma Meershoek-Klein Kranenbarg, Cornelis J.H. van de Velde, Carien L. Creutzberg, and Corrie A.M. Marijnen, Leiden University Medical Center, Leiden; Ina M. Jürgenliemk-Schulz, University Medical Center Utrecht, Utrecht; Jan J. Jobsen, Medisch Spectum Twente, Enschede; Iris D. Nagtegaal, Radboud University Medical Center, Nijmegen; and Harm J.T. Rutten, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.

2 Lisette M. Wiltink, Remi A. Nout, Marta Fiocco, Elma Meershoek-Klein Kranenbarg, Cornelis J.H. van de Velde, Carien L. Creutzberg, and Corrie A.M. Marijnen, Leiden University Medical Center, Leiden; Ina M. Jürgenliemk-Schulz, University Medical Center Utrecht, Utrecht; Jan J. Jobsen, Medisch Spectum Twente, Enschede; Iris D. Nagtegaal, Radboud University Medical Center, Nijmegen; and Harm J.T. Rutten, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.