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Japanese Journal of Clinical Oncology Advance Access published online on December 20, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi208
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© 2005 Foundation for Promotion of Cancer Research
Received August 11, 2005
Accepted October 20, 2005

Original Article

Second Primary Cancers in Patients with Stage III Non-Small Cell Lung Cancer Successfully Treated with Chemo-radiotherapy

Tomoya Kawaguchi 1 *, Akihide Matsumura 2, Keiji Iuchi 2, Seiji Ishikawa 3, Hajime Maeda 4, Shimao Fukai 5, Hikotaro Komatsu 6, and Masaaki Kawahara 1

1 National Hospital Study Group for Lung Cancer in Japan; Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka, Japan
2 National Hospital Study Group for Lung Cancer in Japan; Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Osaka, Japan
3 National Hospital Study Group for Lung Cancer in Japan; National Hospital Organization Okinawa Hospital, Ginowan, Okinawa, Japan
4 National Hospital Study Group for Lung Cancer in Japan; National Hospital Organization Toneyama Hospital, Toyonaka, Osaka, Japan
5 National Hospital Study Group for Lung Cancer in Japan; National Hospital Organization Ibaragi-Higashi Hospital, Naka-gun, Ibaraki, Japan
6 National Hospital Study Group for Lung Cancer in Japan; National Hospital Organization Matsumoto Hospital, Matsumoto, Nagano, Japan

* To whom correspondence should be addressed.
Tomoya Kawaguchi, E-mail: t-kawaguchi{at}kch.hosp.go.jp


  Abstract

Background: Patients successfully treated for non-small cell lung cancer (NSCLC) remain at risk for developing second primary cancer (SPC). The purpose of the current study is to assess the incidence of SPC and the impact of smoking status on the SPC in long-term survivors with stage III NSCLC after chemo-radiotherapy.

Methods: Using the database from the Japan National Hospital Lung Cancer Study Group between 1985 and 1995, information was obtained on 62 patients who were more than 3 years disease-free survivors. Details of clinical information and most smoking history were available from the questionnaire.

Results: Nine of the 62 patients developed SPC 3.9-12.2 years (median, 6.2 years) after the initiation of the treatment. The site of SPC was 2 lung, 1 esophagus, 2 stomach, 1 colon, 1 breast, 1 skin and 1 leukemia. Among these nine, three cancers occurred inside the radiation field. The relative risk of any SPC was 2.8 [95% confidence interval (CI) 1.3-5.3]. The risk changed with the passage of time and it increased significantly (5.2 times at or beyond 7 years) after the treatment. In univariate analysis, the patients who were male, had more cumulative smoking and continued smoking, had an increased risk of SPC [relative risk (RR) 2.7, CI 1.1-5.3; RR 3.0, CI 1.2-6.2; RR 5.2, CI 1.6-11.7, respectively]. In multivariate analysis, factors including smoking status and histological type had no effect on the development of a SPC.

Conclusion: The patients with stage III NSCLC successfully treated with chemo-radiotherapy were at risk for developing SPC and this risk increased with time.

Keywords: second primary cancer; non-small cell lung cancer; chemo-radiotherapy.
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