J Gynecol Oncol.  2021 Mar;32(2):e13. 10.3802/jgo.2021.32.e13.

Radiotherapy combined with chemotherapy increases the risk of herpes zoster in patients with gynecological cancers: a nationwide cohort study

Affiliations
  • 1Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
  • 2Department of Radiation Oncology, China Medical University Beigang Hospital, Yunlin, Taiwan
  • 3School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
  • 4Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
  • 5Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
  • 6Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  • 7Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
  • 8College of Medicine, China Medical University, Taichung, Taiwan
  • 9Preventive Medicine Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan

Abstract


Objective
This study aimed to determine the effect of radiotherapy (RT) on the risk of herpes zoster (HZ) in patients with gynecological cancers via a nationwide population-based study.
Methods
Based on patient data obtained from the National Health Insurance Research Database, 1928 gynecological cancer patients were identified with 1:1 matching for RT and non-RT cohorts by age, index date, and cancer type. Another cohort consisting of 964 noncancer individuals matched was used as normal control. The incidence of HZ was compared between cancer patients with and without RT. Age, comorbidities, cancer-related surgery and chemotherapy (CT), and cancer type were adjusted as confounders.
Results
The risk of HZ in cancer patients was higher than that of non-cancer individuals (14.23 versus 8.34 per 1,000 person-years [PY], the adjusted hazard ratio [aHR]=1.38, p=0.044). In the cancer population, the incidence of HZ for the RT and non-RT cohorts was 20.55 versus 10.23 per 1,000 PY, respectively (aHR=1.68, p=0.009). Age >50 years was an independent factor for developing HZ. The 5-year actuarial incidence for patients receiving neither RT nor CT, RT alone, CT alone, and combined modalities was 5.4%, 6.9%, 3.7%, and 9.9%, respectively (p<0.001). In the RT cohort, the risk rose rapidly in the first year, becoming steady thereafter.
Conclusion
This population-based study showed that gynecological cancer patients receiving RT combined with CT had the highest cumulative risk of HZ. Health care professionals should be aware of the potential toxicities.

Keyword

Gynecologic Neoplasms; Herpes Zoster; Cohort Study; Radiotherapy; Chemotherapy
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