Radiation dose and risk of soft tissue and bone sarcoma after breast cancer treatment
Radiation dose and risk of soft tissue and bone sarcoma after breast cancer treatment
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DOI：
10.1007/s10549-004-2472-8
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发表时间：
2005-02-01
影响因子：
3.8
通讯作者：
de Vathaire, F
中科院分区：
文献类型：
--
作者：
Rubino, C;Shamsaldin, A;de Vathaire, F
背景。根据照射剂量和技术方式，量化乳腺癌后软组织和骨肉瘤的发生风险。我们对6597名乳腺癌患者进行了平均8.3年的随访。软组织和骨肉瘤的数量与基于法国普通人群发病率的预期数量进行了比较。在一项巢式病例对照研究中，我们还根据在肉瘤部位接受的辐射剂量估计了肉瘤的风险，该研究包括14名随后发展为肉瘤的乳腺癌患者和98名与乳腺癌诊断年龄、初始治疗时间和随访时间相匹配的对照组。在队列研究中，12名最初接受放射治疗的妇女在随访期间患上了骨或软组织肉瘤。在此期间的预期病例数为1.7例（SIR = 7.0, 95% CI: 3.7-11.7），同期的平均年超额发病率为每10万人年21例。15年累计肉瘤发病率为0.28% （95% CI: 0.10-0.45%）。在病例对照研究中，所有14例患者都在肉瘤部位接受了至少11.8 Gray的治疗，肉瘤部位通常位于受照射区域或上肢同侧。观察到剂量效应关系（p < 0.001）。最佳拟合为二次剂量-反应关系，在高剂量下没有细胞杀伤的负指数项。大于44 Gray的剂量比小于15 Gray的剂量发生肉瘤的风险高30.6%。高剂量的辐射会大大增加患骨和软组织肉瘤的风险。
Background. To quantify the risk of soft tissue and bone sarcomas after breast cancer according to the doses and technical modalities of irradiation.Methods. We followed a cohort of 6597 breast-cancer patients for 8.3 years on average. The number of soft tissue and bone sarcomas was compared to the expected number based on the incidence rates in the general French population. We also estimated the risk of sarcoma according to the radiation dose received at site of the sarcoma in a nested case-control study of 14 breast-cancer patients who subsequently developed a sarcoma and 98 controls matched for age at diagnosis of breast cancer, period of initial treatment and length of follow-up.Results. In the cohort-study, 12 women who had initially received radiotherapy treatment developed a bone or soft tissue sarcoma during the follow-up period. The expected number of cases during this period was 1.7 (SIR = 7.0, 95% CI: 3.7-11.7) and the mean annual excess incidence during the same period was 21 per 100,000 person-years. The 15-year cumulative incidence of sarcoma was 0.28% (95% CI: 0.10-0.45%). In the case-control study, all the 14 cases had received at least 11.8 Gray at the site of the sarcoma, which was always located in the irradiated field or in the upper ipsilateral extremity of the arm. A dose-effect relationship was observed (p < 0.001). The best fit was obtained for a quadratic dose-response relationship, without a negative exponential term for cell killing at high doses. The risk of sarcoma was 30.6 higher for doses of more than 44 Gray than for doses of less than 15 Gray.Conclusions. High doses of radiation strongly increase the risk of bone and soft tissue sarcoma.