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Research Letter
October 2016

Second Primary Cancers After Intensity-Modulated vs 3-Dimensional Conformal Radiation Therapy for Prostate Cancer

Author Affiliations
  • 1Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
  • 2Department of Radiation Oncology, Abramson Cancer Center, Philadelphia, Pennsylvania
  • 3Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
JAMA Oncol. 2016;2(10):1368-1370. doi:10.1001/jamaoncol.2016.1368

Intensity-modulated radiation therapy (IMRT) is commonly used for patients with prostate cancer because it allows dose escalation to the tumor while reducing radiation exposure to surrounding healthy tissues such as the bladder and rectum.1,2 This reduction may be at the expense of increased radiation exposure to more distant tissues from scatter radiation, particularly the red bone marrow, compared with the exposure from 3-dimensional conformal radiotherapy (3D-CRT), the previous standard radiotherapy technique.1 Simulation studies have suggested this reduced radiation exposure could double the risk of second primary cancers.3 To date, however, no observational studies have directly compared second cancer rates after IMRT to 3D-CRT for prostate cancer.4 We compared the risks of leukemia and myelodysplasia (of particular concern given the potentially higher bone marrow dose and because they can occur as early as 2 years after exposure5) and second solid cancers after IMRT vs 3D-CRT in a large cohort of prostate cancer patients.

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