Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.
Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.
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DOI：
10.1016/j.ijrobp.2008.04.067
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发表时间：
2008-09-01
影响因子：
7
通讯作者：
Mendenhall, Nancy
中科院分区：
文献类型：
--
作者：
Constine, Louis S.;Tarbell, Nancy;Hudson, Melissa M.;Schwartz, Cindy;Fisher, Susan G.;Muhs, Ann G.;Basu, Swati K.;Kun, Larry E.;Ng, Andrea;Mauch, Peter;Sandhu, Ajay;Culakova, Eva;Lyman, Gary;Mendenhall, Nancy
随后的恶性肿瘤(SMN)是治疗霍奇金氏病(HD)儿童发病率和死亡率的主要原因。我们评估了与SMN相关的人口统计学和治疗因素，特别是性别和辐射剂量。研究对象是1960年至1990年间在五家机构接受HD治疗的930名儿童。平均确诊年龄为13.6岁，平均随访时间为16.8年(最长为39.4岁)。治疗包括单纯放疗(43%)、单独化疗(9%)或两者兼用(48%)。我们发现102例(11%)患者发生SMN，25年精算率为19%。在15,154个病人年的随访中，只有7.18例癌症被预期(标准化发病率比[SIR]=14.2；绝对超额风险[AER]=63例/10,000年)。女性受试者的SIR为19.93%，显著高于男性的8.41%(p<；0.0001)。排除乳腺癌后，女性患者的SIR为15.4%，仍显著高于男性患者(p=0.0012)。辐射剂量的增加与SIR的增加相关(p=0.0085)。在单变量分析中，风险增加与女性性别、增加的辐射剂量和治疗时的年龄(12-16岁)有关。使用Logistic回归分析，外套膜辐射剂量增加了风险，主要因为乳腺癌而接受超过35Gy射线治疗的女性患者的风险增加了2.5倍。儿童HD的幸存者有患SMN的风险，即使考虑到乳腺癌，这种风险对女性个人来说也更大。虽然SMN发生在没有放射治疗的情况下，但风险随着放疗剂量的增加而增加。
Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose. A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%). We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12–16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer. Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.
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影响因子：
45.3
作者：
Bonadonna, G;Bonfante, V;Valagussa, P
通讯作者：
Valagussa, P
影响因子：
45.3
作者：
Donaldson, SS;Hudson, MM;Weinstein, HJ
通讯作者：
Weinstein, HJ
影响因子：
45.3
作者：
DONALDSON, SS;LINK, MP
通讯作者：
LINK, MP
影响因子：
45.3
作者：
Green, DM;Hyland, A;Zevon, MA
通讯作者：
Zevon, MA
影响因子：
6.4
作者：
KALDOR, JM;DAY, NE;STORM, HH
通讯作者：
STORM, HH