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Short- and long-term risks of cardiovascular disease following radiotherapy in rectal cancer in four randomized controlled trials and a population-based register
Karolinska Inst, Dept Med Solna, Div Clin Epidemiol, Stockholm, Sweden.
Karolinska Inst, Dept Med Solna, Div Clin Epidemiol, Stockholm, Sweden.
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Karolinska Inst, Dept Med Solna, Div Clin Epidemiol, Stockholm, Sweden.
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2018 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 126, no 3, p. 424-430Article in journal (Refereed) Published
Abstract [en]

Aim: A population-based cohort and four randomized trials enriched with long-term register data were used to clarify if radiotherapy in combination with rectal cancer surgery is associated with increased risks of cardiovascular disease (CVD). Methods: We identified 14,901 rectal cancer patients diagnosed 1995-2009 in Swedish nationwide registers, of whom 9227 were treated with preoperative radiotherapy. Also, we investigated 2675 patients with rectal cancer previously randomized to preoperative radiotherapy or not followed by surgery in trials conducted 1980-1999. Risks of CVD overall and subtypes were estimated based on prospectively recorded hospital visits during relapse-free follow-up using multivariable Cox regression. Maximum follow-up was 18 and 33 years in the register and trials, respectively. Results: We found no association between preoperative radiotherapy and overall CVD risk in the register (Incidence Rate Ratio, IRR = 0.99, 95% confidence interval (CI) 0.92-1.06) or in the pooled trials (IRR = 1.07, 95% CI 0.93-1.24). We noted an increased risk of venous thromboembolism among irradiated patients in both cohorts (lRR(register) = 1.41, 95% CI 1.15-2.72; IRRtrials = 1.41, 95% CI 0.97-2.04), that remained during the first 6 months following surgery among patients treated 2006-2009, after the introduction of antithrombotic treatment (IRR6 (months) = 2.30, 95% CI 1.01-5.21). However, the absolute rate difference of venous thromboembolism attributed to RT was low (10 cases per 1000 patients and year). Discussion: Preoperative radiotherapy did not affect rectal cancer patients' risk of CVD overall. Although an excess risk of short-term venous thromboembolism was noted, the small increase in absolute numbers does not call for general changes in routine prophylactic treatment, but might do so for patients already at high risk of venous thromboembolism. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2018. Vol. 126, no 3, p. 424-430
Keywords [en]
Rectal cancer, Radiotherapy, Population-based cohorts, Randomized controlled trials, Long-term cardiovascular disease, Venous thromboembolism
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-352739DOI: 10.1016/j.radonc.2017.12.008ISI: 000429762700006PubMedID: 29306497OAI: oai:DiVA.org:uu-352739DiVA, id: diva2:1214598
Funder
Swedish Cancer SocietyAvailable from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved

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Glimelius, IngridGlimelius, Bengt

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