Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer

A Population-Based Study

Rong Wang, Amer M. Zeidan, James B. Yu, Pamela R. Soulos, Amy J. Davidoff, Steven D. Gore, Scott F. Huntington, Cary P. Gross, Xiaomei Ma

Research output: Contribution to journalArticle

Abstract

BACKGROUND: To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS: We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS: Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR=1.66, 95% CI: 1.09-2.54). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions.

Original languageEnglish (US)
JournalProstate
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Myelodysplastic Syndromes
Acute Myeloid Leukemia
Prostatic Neoplasms
Radiotherapy
Population
Intensity-Modulated Radiotherapy
Confidence Intervals
Conformal Radiotherapy
National Cancer Institute (U.S.)
Brachytherapy
Medicare
Epidemiology
Cohort Studies
Retrospective Studies
Databases
Physicians

Keywords

  • Acute myeloid leukemia
  • Myelodysplastic syndromes
  • Prostate cancer
  • Radiotherapy
  • Second cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Wang, R., Zeidan, A. M., Yu, J. B., Soulos, P. R., Davidoff, A. J., Gore, S. D., ... Ma, X. (Accepted/In press). Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study. Prostate. https://doi.org/10.1002/pros.23281

Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer : A Population-Based Study. / Wang, Rong; Zeidan, Amer M.; Yu, James B.; Soulos, Pamela R.; Davidoff, Amy J.; Gore, Steven D.; Huntington, Scott F.; Gross, Cary P.; Ma, Xiaomei.

In: Prostate, 2016.

Research output: Contribution to journalArticle

Wang, R, Zeidan, AM, Yu, JB, Soulos, PR, Davidoff, AJ, Gore, SD, Huntington, SF, Gross, CP & Ma, X 2016, 'Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study', Prostate. https://doi.org/10.1002/pros.23281
Wang, Rong ; Zeidan, Amer M. ; Yu, James B. ; Soulos, Pamela R. ; Davidoff, Amy J. ; Gore, Steven D. ; Huntington, Scott F. ; Gross, Cary P. ; Ma, Xiaomei. / Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer : A Population-Based Study. In: Prostate. 2016.
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title = "Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study",
abstract = "BACKGROUND: To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS: We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS: Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47{\%}) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95{\%} confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR=1.66, 95{\%} CI: 1.09-2.54). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions.",
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AU - Wang, Rong

AU - Zeidan, Amer M.

AU - Yu, James B.

AU - Soulos, Pamela R.

AU - Davidoff, Amy J.

AU - Gore, Steven D.

AU - Huntington, Scott F.

AU - Gross, Cary P.

AU - Ma, Xiaomei

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N2 - BACKGROUND: To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS: We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS: Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR=1.66, 95% CI: 1.09-2.54). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions.

AB - BACKGROUND: To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS: We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS: Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR=1.66, 95% CI: 1.09-2.54). CONCLUSIONS: Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions.

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KW - Myelodysplastic syndromes

KW - Prostate cancer

KW - Radiotherapy

KW - Second cancer

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