Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
September 13, 2026 · via Europe PMC
Risk and prognostic survival analysis of radiation-related second malignant neoplasms following radiotherapy for nasopharyngeal carcinoma: intensity-modulated radiotherapy and two-dimensional radiotherapy.
Huang R, Lou J, Li C, +7 more, Chen L
AI summary — for doctors, generated from the abstract only
Among nasopharyngeal carcinoma survivors, the IMRT cohort showed a higher crude incidence and shorter latency of radiation-related second malignancies than the historical 2D-RT cohort, with male sex, younger age and smoking as risk factors.
What was studied
A cross-era institutional study of 8,032 IMRT-treated and 39,118 2D-RT-treated non-metastatic NPC patients assessing radiation-related second malignant neoplasms.
Key findings
- Crude SMN proportions 3.49% (IMRT) vs 0.63% (2D-RT)
- IMRT cumulative incidence 1.15%, 3.09% and 6.66% at 5, 10 and 15 years
- Median latency 7.3 years (IMRT) vs 9.5 years (2D-RT)
- Oral cavity and sinonasal sites and squamous histology most common
- Male sex, age ≤50 and smoking independently associated with SMN
- 5-year OS after SMN 38.6% (IMRT) vs 29.3% (2D-RT)
Clinical relevance
This supports long-term surveillance for second cancers in NPC survivors, especially younger men and smokers, though the cross-era comparison is prone to detection and follow-up biases.
Who should care
Limitations
Retrospective single-institution cross-era comparison with differences in follow-up, surveillance intensity and imaging.
Second cancers after NPC radiotherapy are a real long-term risk warranting extended follow-up.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND AND PURPOSE
To clarify the long-term risk and prognostic implications of second malignant neoplasms (SMNs) among nasopharyngeal carcinoma survivors in intensity-modulated radiotherapy (IMRT) and historical two-dimensional radiotherapy (2D-RT) cohorts.
MATERIALS AND METHODS
We extracted data from 8,032 and 39,118 initially diagnosed, non-metastatic NPC patients treated with IMRT ± chemotherapy and 2D-RT ± chemotherapy, respectively. Risk factors for SMN development in the IMRT cohort were evaluated using univariate and multivariable Cox proportional hazards models. Survival outcomes were assessed using the Kaplan-Meier method.
RESULTS
Radiation-related SMNs occurred in 212 patients in the IMRT cohort and 247 patients in the historical 2D-RT cohort, corresponding to observed crude proportions of 3.49% and 0.63%, respectively. In the IMRT cohort, the 5-, 10-, and 15-year competing-risk cumulative incidences were 1.15%, 3.09%, and 6.66%, respectively. Median latency to SMN diagnosis was 7.3 years in the IMRT cohort and 9.5 years in the historical 2D-RT cohort. The oral cavity and sinonasal region were common SMN sites, and squamous cell carcinoma was the predominant histology. In multivariable Cox analysis within the IMRT cohort, male sex, age ≤ 50 years, and smoking history were independently associated with SMN development. Among patients with SMNs, 5-year overall survival was 38.6% in the IMRT cohort and 29.3% in the historical 2D-RT cohort.
CONCLUSIONS
In this cross-era institutional study, the IMRT cohort showed a numerically higher observed crude incidence and shorter latency of radiation-related SMNs than the historical 2D-RT cohort. Male sex, younger age, and smoking history were independent risk factors for SMN development. Among patients who developed SMNs, observed overall survival estimates were higher in the IMRT cohort.
DOI
10.1016/j.radonc.2026.111776
PMID
42732821
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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