Second primary malignancy risk after radiotherapy in rectal cancer survivors

AIM To investigate second primary malignancy (SPM) risk after radiotherapy in rectal cancer survivors METHODS We used Taiwan's National Health Insurance Research Database to identify rectal cancer patients between 1996 and 2011. Surgery-alone, preoperative short course, preoperative long course, and post-operative radiotherapy groups were defined. The overall and site-specific SPM incidence rates were compared among the radiotherapy groups by multivariate Cox regression, taking chemotherapy and comorbidities into account. Sensitivity tests were performed for attained-year adjustment and long-term survivors analysis. RESULTS A total of 28220 patients were analyzed. The 10-year cumulative SPM incidence was 7.8% [95% confidence interval (CI): 7.2%-8.2%] using a competing risk model. The most common sites of SPM were the lung, liver, and prostate. Radiotherapy was not associated with increased SPM risk in multi-variate Cox model (hazard ratio = 1.05, 95%CI: 0.91-1.21, P = 0.494). The SPM hazard remained unchanged in 10-year-survivors. In addition, no SPM risk difference was found between the preoperative radiotherapy and postoperative radiotherapy groups. CONCLUSION In this large population-based cohort study, we de- monstrated that radiotherapy had no increase in SPM.