{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T01:55:39Z","timestamp":1790474139661,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,2,10]],"date-time":"2016-02-10T00:00:00Z","timestamp":1455062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We investigated the association between external beam radiotherapy (<jats:styled-content style=\"fixed-case\">EBRT<\/jats:styled-content>) and pleural and peritoneal mesothelioma among long\u2010term (&gt;5\u00a0years) solid cancer survivors. We analyzed data from the <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> Surveillance, Epidemiology, and End Results (<jats:styled-content style=\"fixed-case\">SEER<\/jats:styled-content>) program (1973\u20132012). We fitted survival models adjusted by age, gender, race, year, surgery, and relative risk of primary mesothelioma in the county of residence (proxy for individual asbestos exposure). We estimated hazard ratios [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>] with reference to nonirradiated patients. We distinguished between scattered and direct irradiation to study the dose\u2013response. We observed 301 mesotheliomas (265 pleural; 32 peritoneal; 4 others) among 935,637 patients. <jats:styled-content style=\"fixed-case\">EBRT<\/jats:styled-content> increased the risk of mesothelioma (any site; <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.34, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.04\u20131.77). We observed an increased risk of pleural mesothelioma (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> for <jats:styled-content style=\"fixed-case\">EBRT<\/jats:styled-content> 1.34, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.01\u20131.77), but we did not find signs of a dose\u2013response relationship (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> for scattered irradiation 1.38; <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> for direct irradiation 1.23). On the opposite, only direct peritoneal irradiation was associated with peritoneal mesothelioma (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.20, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.99\u20134.88), particularly for latencies \u226510\u00a0years (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 3.28, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.14\u20139.43). A competing risks analysis revealed that the clinical impact of radiation\u2010induced mesothelioma was limited by the high frequency of competing events. The cumulative incidence function of mesothelioma after 40\u00a0years of observation was very low (nonirradiated patients 0.00032, irradiated patients 0.00055).<jats:styled-content style=\"fixed-case\">EBRT<\/jats:styled-content> might be a determinant of mesothelioma. Longer latency periods are associated with higher risks, while the dose\u2013response seems nonlinear. The clinical impact of mesothelioma after <jats:styled-content style=\"fixed-case\">EBRT<\/jats:styled-content> for primary solid cancers is limited.<\/jats:p>","DOI":"10.1002\/cam4.656","type":"journal-article","created":{"date-parts":[[2016,2,10]],"date-time":"2016-02-10T12:04:09Z","timestamp":1455105849000},"page":"950-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Radiation\u2010induced mesothelioma among long\u2010term solid cancer survivors: a longitudinal analysis of <scp>SEER<\/scp> database"],"prefix":"10.1002","volume":"5","author":[{"given":"Andrea","family":"Farioli","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC) University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ottone","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC) University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio G.","family":"Morganti","sequence":"additional","affiliation":[{"name":"Deptartments of Experimental Diagnostic and Specialty Medicine \u2010 DIMES Radiation Oncology Center University of Bologna S.Orsola\u2010Malpighi Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Compagnone","sequence":"additional","affiliation":[{"name":"Department of Medical Physics S.Orsola\u2010Malpighi University Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Romani","sequence":"additional","affiliation":[{"name":"Department of Medical Physics S.Orsola\u2010Malpighi University Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Cammelli","sequence":"additional","affiliation":[{"name":"Deptartments of Experimental Diagnostic and Specialty Medicine \u2010 DIMES Radiation Oncology Center University of Bologna S.Orsola\u2010Malpighi Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Mattioli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC) University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco S.","family":"Violante","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC) University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-3-34"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh025"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-009-9328-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0039-RA"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-009-9357-4"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-013-0230-0"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1667\/RR0763.1"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.12.012"},{"key":"e_1_2_7_10_1","first-page":"1","volume-title":"New malignancies among cancer survivors: SEER cancer registries, 1973\u20132000","author":"Fraumeni J. 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