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@ARTICLE{Obi:132847,
      author       = {N. Obi and C. Eulenburg and P. Seibold$^*$ and U.
                      Eilber$^*$ and K. Thöne and S. Behrens$^*$ and J.
                      Chang-Claude$^*$ and D. Flesch-Janys},
      title        = {{A}ssociations between adjuvant radiotherapy and different
                      causes of death in a {G}erman breast cancer cohort.},
      journal      = {The breast},
      volume       = {38},
      issn         = {0960-9776},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2018-00490},
      pages        = {75 - 80},
      year         = {2018},
      abstract     = {Studies of cohorts of breast cancer (BC) patients diagnosed
                      before 1990 showed radiotherapy (RT) to be associated with
                      increased cardiovascular (CVD) and lung cancer mortality
                      many years after diagnosis. In the late 1990s, improvements
                      in RT planning techniques reduced radiation doses to normal
                      tissues. Recent studies did not consistently report higher
                      RT-related mortality for CVD and second cancers. Aim of the
                      study was to analyze specific causes of death after
                      3D-conformal RT in a recent BC cohort.Stage I-III BC
                      patients diagnosed 2001-2005 and enrolled in the population
                      based MARIEplus study were followed-up for 11.9 years
                      (median). Associations between adjuvant RT and
                      cause-specific mortality were analyzed by using competing
                      risks models, yielding subdistribution hazard ratios (SHR)
                      for RT directly related to cumulative incidences. Models
                      were adjusted for differences in baseline characteristics
                      applying inverse-probability-of-treatment-weighting
                      (IPTW).Of the 2951 patients, 2439 $(83.0\%)$ received RT. No
                      significant association of RT with lung cancer mortality
                      (SHRIPTW 0.88, 0.35-2.12), other cancer mortality (SHRIPTW
                      1.04, $95\%$ CI 0.62-1.73) or cardiac mortality was observed
                      (SHRIPTW 1.57, 0.75-3.29). Mortality from lung and other
                      diseases were significantly lower in irradiated women
                      (SHRIPTW 0.39, $95\%$ CI 0.17-0.90 and SHRIPTW 0.58, $95\%$
                      CI 0.34-0.97, respectively).In line with recent studies,
                      3D-conformal RT did not significantly increase mortality
                      from non-BC causes in the German MARIEplus cohort. Since
                      long-term data are still sparse and event rates low in
                      BC-cohorts, who received modern RT, investigation of
                      possible late RT effects on mortality beyond 14 years of
                      follow-up is warranted.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29248876},
      doi          = {10.1016/j.breast.2017.12.006},
      url          = {https://inrepo02.dkfz.de/record/132847},
}