The association between radiotherapy and the risk of second primary lung cancer among female breast cancer patients: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MA Jun , ZHANG Zhiguang , HU Yunhai

Department of Thoracic Surgery, Pidu District People's Hospital, Chengdu, 611700, P. R. China;

Corresponding author：

MA Jun, Email: majun9558@sina.com

Keywords：

Radiotherapy; female; breast cancer; lung cancer; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202107028

Video：

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Objective To explore the association between radiotherapy and the risk of subsequent primary lung cancer in female patients with breast cancer. Methods The EMbase, Web of Science, PubMed, CNKI, VIP and WanFang databases were searched from the establishment date to July 1, 2021. The relative risk (RR) with 95% confidence interval (CI) were combined and all statistical analyses were performed by STATA 12.0 software. Results A total of 10 publications including 466 510 participates from 14 studies were included. The meta-analysis indicated that radiotherapy was a risk factor for the occurrence of second primary lung cancer among female breast cancer patients [RR=1.45, 95%CI (1.18, 1.78), P<0.001]. Subgroup analysis based on the relative position of breast cancer and lung cancer was conducted and the results demonstrated that radiotherapy only increased the incidence rate of ipsilateral lung cancer [RR=1.27, 95%CI (1.10, 1.45), P=0.001], without significant change of the risk of contralateral lung cancer [RR=1.16, 95%CI (0.77, 1.74), P=0.487]. Conclusion Radiotherapy is one of the risk factors for subsequent primary pulmonary carcinoma among female breast cancer patients, especially for ipsilateral lung carcinoma. However, more high-quality studies are still needed to verify above findings.

Citation： MA Jun, ZHANG Zhiguang, HU Yunhai. The association between radiotherapy and the risk of second primary lung cancer among female breast cancer patients: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1641-1646. doi: 10.7507/1007-4848.202107028 Copy

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2.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3.	Nascimento JHF, Vieira ATS, Souza Filho BM, et al. Breast cancer in Brazil: Screening program and surgical approach. Cancer Epidemiol, 2021, 73: 101970.
4.	Silverman BG, Lipshitz I, Keinan-Boker L. Second primary cancers after primary breast cancer diagnosis in Israeli women, 1992 to 2006. J Glob Oncol, 2016, 3(2): 135-142.
5.	Yi M, Cormier JN, Xing Y, et al. Other primary malignancies in breast cancer patients treated with breast conserving surgery and radiation therapy. Ann Surg Oncol, 2013, 20(5): 1514-1521.
6.	Mellemkjaer L, Friis S, Olsen JH, et al. Risk of second cancer among women with breast cancer. Int J Cancer, 2006, 118(9): 2285-2292.
7.	Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10, 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
8.	Solin LJ. Breast conservation treatment with radiation: An ongoing success story. J Clin Oncol, 2010, 28(5): 709-711.
9.	Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol, 2017, 35(15): 1641-1649.
10.	王彦, 林琳, 戢艳丽, 等. 术前红细胞分布宽度与食管癌患者预后关系的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1247-1251.
11.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12.	Obedian E, Fischer DB, Haffty BG. Second malignancies after treatment of early-stage breast cancer: Lumpectomy and radiation therapy versus mastectomy. J Clin Oncol, 2000, 18(12): 2406-2412.
13.	Deutsch M, Land SR, Begovic M, et al. The incidence of lung carcinoma after surgery for breast carcinoma with and without postoperative radiotherapy. Results of National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials B-04 and B-06. Cancer, 2003, 98(7): 1362-1368.
14.	Zablotska LB, Neugut AI. Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Cancer, 2003, 97(6): 1404-1411.
15.	Roychoudhuri R, Evans H, Robinson D, et al. Radiation-induced malignancies following radiotherapy for breast cancer. Br J Cancer, 2004, 91(5): 868-872.
16.	Levi F, Randimbison L, Te VC, et al. Cancer risk after radiotherapy for breast cancer. Br J Cancer, 2006, 95(3): 390-392.
17.	Andersson M, Jensen MB, Engholm G, et al. Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer Cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977-2001. Acta Oncol, 2008, 47(4): 755-764.
18.	Schaapveld M, Visser O, Louwman MJ, et al. Risk of new primary nonbreast cancers after breast cancer treatment: A Dutch population-based study. J Clin Oncol, 2008, 26(8): 1239-1246.
19.	Bazire L, De Rycke Y, Asselain B, et al. Risks of second malignancies after breast cancer treatment: Long-term results. Cancer Radiother, 2017, 21(1): 10-15.
20.	Huang YJ, Huang TW, Lin FH, et al. Radiation therapy for invasive breast cancer increases the risk of second primary lung cancer: A nationwide population-based cohort analysis. J Thorac Oncol, 2017, 12(5): 782-790.
21.	DiMarzio P, Peila R, Dowling O, et al. Smoking and alcohol drinking effect on radiotherapy associated risk of second primary cancer and mortality among breast cancer patients. Cancer Epidemiol, 2018, 57: 97-103.
22.	Saeed H, Johnstone C, King DM, et al. The impact of 3d conformal radiotherapy versus intensity-modulated radiotherapy on post-operative wound complications in soft tissue sarcomas of the extremity and chest-wall. J Radiat Oncol, 2016, 5(4): 389-94.
23.	Winther-Larsen A, Aggerholm-Pedersen N, Sandfeld-Paulsen B. Inflammation scores as prognostic biomarkers in small cell lung cancer: A systematic review and meta-analysis. Syst Rev, 2021, 10(1): 40.
24.	Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer, 2020, 126(15): 3560-3568.
25.	Zhang Q, Liu J, Ao N, et al. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci Rep, 2020, 10(1): 1220.
26.	Zurl B, Stranzl H, Winkler P, et al. Quantitative assessment of irradiated lung volume and lung mass in breast cancer patients treated with tangential fields in combination with deep inspiration breath hold (DIBH). Strahlenther Onkol, 2010, 186(3): 157-162.
27.	Kishi K, Sonomura T, Shirai S, et al. Critical organ preservation in reirradiation brachytherapy by injectable spacer. Int J Radiat Oncol Biol Phys, 2009, 75(2): 587-594.

1. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer, 2021. [Epub ahead of print].
2. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3. Nascimento JHF, Vieira ATS, Souza Filho BM, et al. Breast cancer in Brazil: Screening program and surgical approach. Cancer Epidemiol, 2021, 73: 101970.
4. Silverman BG, Lipshitz I, Keinan-Boker L. Second primary cancers after primary breast cancer diagnosis in Israeli women, 1992 to 2006. J Glob Oncol, 2016, 3(2): 135-142.
5. Yi M, Cormier JN, Xing Y, et al. Other primary malignancies in breast cancer patients treated with breast conserving surgery and radiation therapy. Ann Surg Oncol, 2013, 20(5): 1514-1521.
6. Mellemkjaer L, Friis S, Olsen JH, et al. Risk of second cancer among women with breast cancer. Int J Cancer, 2006, 118(9): 2285-2292.
7. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10, 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
8. Solin LJ. Breast conservation treatment with radiation: An ongoing success story. J Clin Oncol, 2010, 28(5): 709-711.
9. Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol, 2017, 35(15): 1641-1649.
10. 王彦, 林琳, 戢艳丽, 等. 术前红细胞分布宽度与食管癌患者预后关系的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1247-1251.
11. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12. Obedian E, Fischer DB, Haffty BG. Second malignancies after treatment of early-stage breast cancer: Lumpectomy and radiation therapy versus mastectomy. J Clin Oncol, 2000, 18(12): 2406-2412.
13. Deutsch M, Land SR, Begovic M, et al. The incidence of lung carcinoma after surgery for breast carcinoma with and without postoperative radiotherapy. Results of National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials B-04 and B-06. Cancer, 2003, 98(7): 1362-1368.
14. Zablotska LB, Neugut AI. Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Cancer, 2003, 97(6): 1404-1411.
15. Roychoudhuri R, Evans H, Robinson D, et al. Radiation-induced malignancies following radiotherapy for breast cancer. Br J Cancer, 2004, 91(5): 868-872.
16. Levi F, Randimbison L, Te VC, et al. Cancer risk after radiotherapy for breast cancer. Br J Cancer, 2006, 95(3): 390-392.
17. Andersson M, Jensen MB, Engholm G, et al. Risk of second primary cancer among patients with early operable breast cancer registered or randomised in Danish Breast Cancer Cooperative Group (DBCG) protocols of the 77, 82 and 89 programmes during 1977-2001. Acta Oncol, 2008, 47(4): 755-764.
18. Schaapveld M, Visser O, Louwman MJ, et al. Risk of new primary nonbreast cancers after breast cancer treatment: A Dutch population-based study. J Clin Oncol, 2008, 26(8): 1239-1246.
19. Bazire L, De Rycke Y, Asselain B, et al. Risks of second malignancies after breast cancer treatment: Long-term results. Cancer Radiother, 2017, 21(1): 10-15.
20. Huang YJ, Huang TW, Lin FH, et al. Radiation therapy for invasive breast cancer increases the risk of second primary lung cancer: A nationwide population-based cohort analysis. J Thorac Oncol, 2017, 12(5): 782-790.
21. DiMarzio P, Peila R, Dowling O, et al. Smoking and alcohol drinking effect on radiotherapy associated risk of second primary cancer and mortality among breast cancer patients. Cancer Epidemiol, 2018, 57: 97-103.
22. Saeed H, Johnstone C, King DM, et al. The impact of 3d conformal radiotherapy versus intensity-modulated radiotherapy on post-operative wound complications in soft tissue sarcomas of the extremity and chest-wall. J Radiat Oncol, 2016, 5(4): 389-94.
23. Winther-Larsen A, Aggerholm-Pedersen N, Sandfeld-Paulsen B. Inflammation scores as prognostic biomarkers in small cell lung cancer: A systematic review and meta-analysis. Syst Rev, 2021, 10(1): 40.
24. Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer, 2020, 126(15): 3560-3568.
25. Zhang Q, Liu J, Ao N, et al. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci Rep, 2020, 10(1): 1220.
26. Zurl B, Stranzl H, Winkler P, et al. Quantitative assessment of irradiated lung volume and lung mass in breast cancer patients treated with tangential fields in combination with deep inspiration breath hold (DIBH). Strahlenther Onkol, 2010, 186(3): 157-162.
27. Kishi K, Sonomura T, Shirai S, et al. Critical organ preservation in reirradiation brachytherapy by injectable spacer. Int J Radiat Oncol Biol Phys, 2009, 75(2): 587-594.

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The association between radiotherapy and the risk of second primary lung cancer among female breast cancer patients: A systematic review and meta-analysis

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