Radiation and genetic factors in the risk of second malignant neoplasms after a first cancer in childhood
Radiation and genetic factors in the risk of second malignant neoplasms after a first cancer in childhood
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DOI：
10.1016/s0140-6736(97)01116-1
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发表时间：
1997-07-12
期刊：
影响因子：
168.9
通讯作者：
BonaitiPellie, C
中科院分区：
文献类型：
--
作者：
Kony, SJ;deVathaire, F;BonaitiPellie, C
背景放疗和化疗与继发性恶性肿瘤（SMN）的风险增加有关。SMN和家族聚集性之间的关联也已被证明。本研究的目的是探讨家庭因素的作用，SMM的风险和潜在的相互作用与treatment.Methods的效果，我们设计了一个病例对照研究的25名儿童SMN（病例）和96名儿童没有SMN后，癌症治疗（对照），从一个队列的649名儿童在我们的机构治疗1953年和1985年之间。获得患者和对照组的完整家族史，并定义家族指数以评估家族聚集程度。在151个网站在体内的辐射剂量估计为每个放疗course for each child.Findings在家庭成员的25 SMN的情况下，有10个早发性（小于或等于45岁）癌症，相比之下，8个亲属的96个控制。与没有早发性癌症家族史的患者相比，有一个或多个受累家族成员的患者SMN的比值比为4.7（95% CI 1.3-17.1; p=0.02）。调整局部辐射剂量和排除已知易患SMN的患者（p53突变的携带者和雷克林豪森病患者）并不影响这种风险substantial.Interpretation遗传因素和电离辐射暴露对SMN的风险有独立的影响。当有早发性癌症家族史时，对接受癌症治疗的儿童的随访应特别警惕。
Background Radiotherapy and chemotherapy are associated with an increased risk of second malignant neoplasm (SMN). An association between SMN and familial aggregation has also been shown. The aim of this study was to investigate the role of familial factors in the risk of SMM and their potential interaction with the effect of treatment.Methods We devised a case-control study of 25 children with SMN (cases) and 96 children with no SMN after a cancer treatment (controls), taken from a cohort of 649 children treated at our institution between 1953 and 1985. A complete family history was obtained for patients and controls and a familial index defined to evaluate the degree of familial aggregation. The radiation dose given at 151 sites in the body was estimated for each radiotherapy course for each child.Findings Among family members of the 25 SMN cases, there were ten with early-onset (less than or equal to 45 years) cancer, compared with eight among relatives of the 96 controls. Compared with patients who had no family history of early-onset cancer, those with one or more affected family members had an odds ratio of SMN of 4.7 (95% Cl 1.3-17.1; p=0.02). Adjustment for local radiation dose and exclusion of patients known to be predisposed to SMN (carriers of p53 mutation and those with Recklinghausen's disease) did not affect this risk substantially.Interpretation Both genetic factors and exposure to ionising radiation have independent effects on the risk of SMN. Follow-up of children treated for cancer should be especially vigilant when there is a family history of early-onset cancer.