{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:29:22Z","timestamp":1793046562270,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T00:00:00Z","timestamp":1589846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The comparative risks of a second cancer diagnosis are uncertain after primary cancer treatment with 3\u2010dimensional conformal radiotherapy (3DCRT), intensity\u2010modulated radiotherapy (IMRT), or proton beam radiotherapy (PBRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pediatric and adult patients with a first cancer diagnosis between 2004 and 2015 who received 3DCRT, IMRT, or PBRT were identified in the National Cancer Database from 9 tumor types: head and neck, gastrointestinal, gynecologic, lymphoma, lung, prostate, breast, bone\/soft tissue, and brain\/central nervous system. The diagnosis of second cancer was modeled using multivariable logistic regression adjusting for age, follow\u2010up duration, radiotherapy (RT) dose, chemotherapy, sociodemographic variables, and other factors. Propensity score matching also was used to balance baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 450,373 patients were identified (33.5% received 3DCRT, 65.2% received IMRT, and 1.3% received PBRT) with median follow\u2010up of 5.1\u00a0years after RT completion and a cumulative follow\u2010up period of 2.54\u00a0million person\u2010years. Overall, the incidence of second cancer diagnosis was 1.55 per 100 patient\u2010years. In a comparison between IMRT versus 3DCRT, there was no overall difference in the risk of second cancer (adjusted odds ratio [OR], 1.00; 95% CI, 0.97\u20101.02;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.75). By comparison, PBRT had an overall lower risk of second cancer versus IMRT (adjusted OR, 0.31; 95% CI, 0.26\u20100.36;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.0001). Results within each tumor type generally were consistent in the pooled analyses and also were maintained in propensity score\u2010matched analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The risk of a second cancer diagnosis was similar after IMRT versus 3DCRT, whereas PBRT was associated with a lower risk of second cancer risk. Future work is warranted to determine the cost\u2010effectiveness of PBRT and to identify the population best suited for this treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.32938","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T15:11:50Z","timestamp":1589901110000},"page":"3560-3568","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":174,"title":["Second cancer risk after primary cancer treatment with three\u2010dimensional conformal, intensity\u2010modulated, or proton beam radiation therapy"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0170-9321","authenticated-orcid":false,"given":"Michael","family":"Xiang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Stanford University Stanford California USA"},{"name":"Palo Alto Veterans Affairs Hospital Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2760-1554","authenticated-orcid":false,"given":"Daniel T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2908-6293","authenticated-orcid":false,"given":"Erqi L.","family":"Pollom","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Stanford University Stanford California USA"},{"name":"Palo Alto Veterans Affairs Hospital Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/genes2041033"},{"key":"e_1_2_8_3_1","volume-title":"New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973\u20102000","author":"Curtis RE","year":"2006"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e3182609ba4"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.72.0722"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc3069"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2015.00261"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10555-016-9616-2"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.09.039"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.6905"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.1368"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.01.040"},{"key":"e_1_2_8_13_1","unstructured":"National Cancer Data Base.Participant User File (PUF) Data Dictionary. 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