Second primary cancer after treatment for cervical cancer. Late effects after radiotherapy
Second primary cancer after treatment for cervical cancer. Late effects after radiotherapy
复制标题
宫颈癌治疗后的第二原发癌。
作者：
H. Storm
利用丹麦人口癌症登记处的数据，对24970名患有浸润性宫颈癌(1943-1982)的妇女和19470名患有宫颈原位癌的妇女进行了第二原发癌的相对风险(RR)评估。分析根据接受(+)和不接受(-)放射治疗的情况进行分层。合并所有第二原发灶，浸润性宫颈癌的RR+=1.1(95%CI=1.06-1.18)，RR-=1.3(95%CI=1.13-1.40)；原位癌RR+=3.5(95%CI=1.4-7.2)，RR-=1.1(95%CI=0.7-1.6)。第二原发癌总体上小幅过剩的原因是一些癌症如肺癌、膀胱癌的增加，而其他癌症如乳腺癌的同时减少。在距宫颈较近和中等距离的浸润性宫颈癌患者中，放射治疗后RR随治疗时间的延长而增加，30年以上随访达最大值(RR=1.9；95%CI=1.4~2.5)。总体而言，这些地点每年每10,000名妇女中超过的病例可归因于30多年幸存者中的辐射。其他生殖器官(RR=5.8；95%CI=1.8~13.0)、膀胱(RR=5.5；95%CI=2.8~9.5)、结缔组织(RR=3.3；95%CI=0.4~12.0)、胃(RR=2.5；95%CI=1.1~4.7)和直肠(RR=2.4；95%CI=1.1~4.6)。在10多年中观察到乳腺癌风险的显著不足(RR=0.7，95%CI=0.6-0.8)，这可能归因于放射治疗卵巢切除的效果。据推测，同样的效应也可以解释观察到的脑肿瘤缺陷(RR=0.6；95%CI=0.4-1.0)和皮肤黑色素瘤(RR=0.6；95%CI=0.3-1.0)。结论是，除了急性非淋巴细胞白血病外，可归因于辐射的癌症往往出现得较晚(放射治疗后10年或更长时间)，而且这种风险在30多年内仍然很高。
Using data from the population‐based Danish Cancer Registry, the relative risk (RR) of second primary cancer was assessed among 24,970 women with invasive cervical cancer (1943–1982) and 19,470 women with carcinoma in situ of the cervix. The analysis was stratified according to treatment with (+) and without (‐) radiation. For all second primaries combined, a RR + = 1.1 (95% confidence interval (CI) = 1.06–1.18) and a RR‐ = 1.3 (95% CI = 1.13–1.40) was observed after invasive cervical cancers and a RR+ = 3.5 (95% CI = 1.4–7.2) and RR‐ = 1.1 (95% CI = 0.7–1.6) following in situ cancer. The small overall excess of second primary cancer is accounted for by an increase of some cancers such as lung, bladder, and a concurrent decrease in others such as breast. Although not statistically different from nonirradiated, the RR increased with time since treatment among irradiated invasive cervical cancer patients in organs close to and at intermediate distance from the cervix, reaching a maximum after 30 or more years of follow‐up (RR = 1.9; 95% CI = 1.4–2.5). Altogether, for these sites an excess of 64 cases per 10,000 women per year were attributable to radiation among survivors of 30+ years. The highest risks among long‐term survivors were observed for the following: other genital organs (RR = 5.8; 95% CI = 1.8–13.0) bladder (RR = 5.5; 95% CI = 2.8–9.5), connective tissue (RR = 3.3; 95% CI = 0.4–12.0), stomach (RR = 2.5; 95% CI = 1.1–4.7) and rectum (RR = 2.4; 95% CI = 1.1–4.6). A significant deficit of risk for breast cancer (RR = 0.7, 95% CI = 0.6–0.8) was observed for 10+ years, may be attributable to the effect of ovarian ablation by radiotherapy. It is speculated that the same effect also may explain the observed deficits of brain tumors (RR = 0.6; 95% CI = 0.4–1.0) and skin melanomas (RR = 0.6; 95% CI = 0.3–1.0). It is concluded that cancers attributable to radiation, apart from acute nonlymphocytic leukemias, tend to appear late (10 or more years after radiotherapy), and that the risk remains elevated for more than 30 years.