BONE SARCOMAS LINKED TO RADIOTHERAPY AND CHEMOTHERAPY IN CHILDREN
BONE SARCOMAS LINKED TO RADIOTHERAPY AND CHEMOTHERAPY IN CHILDREN
复制标题
DOI：
10.1056/nejm198709033171002
复制
发表时间：
1987-09-03
影响因子：
158.5
通讯作者：
FRAUMENI, JF
中科院分区：
文献类型：
--
作者：
TUCKER, MA;DANGIO, GJ;FRAUMENI, JF
我们估计了9170例儿童期癌症诊断后存活2年或2年以上的患者随后患骨癌的风险。与一般人群相比，患者的相对危险度为133（95%置信区间，98 - 176），平均（. ±. SE）20年累积风险为2.8 .+-。0.7百分之详细的治疗数据获得了64例儿童癌症后发生骨癌的患者。与209名儿童时期癌症幸存但后来没有患骨癌的对照组相比，接受过放射治疗的患者的风险为2.7倍（95%置信区间，1.0至7.7），并且在骨剂量超过6000拉德后，剂量反应梯度急剧上升，风险达到40倍。接受视网膜母细胞瘤治疗的患者的相对剂量反应效应与所有其他类型初始肿瘤患者相似，尽管视网膜母细胞瘤组的骨癌累积风险较高。接受正电压和兆电压治疗的患者数量相似;不同剂量类别的风险模式并不因电压类型而异。在调整放射治疗后，烷化剂治疗也与骨癌有关（相对危险度为4.7; 95%置信区间为1.0 ~ 22.3），随着累积药物暴露量的增加，风险也增加。我们的结论是，儿童癌症的放疗和化疗与烷化剂增加随后的骨癌的风险。
We estimated the risk of subsequent bone cancer among 9170 patients who had survived two or more years after the diagnosis of a cancer in childhood. As compared with the general population, the patients had a relative risk of 133 (95 percent confidence interval, 98 to 176) and a mean (.+-.SE) 20-year cumulative risk of 2.8 .+-. 0.7 percent. Detailed data on treatment were obtained on 64 patients in whom bone cancer developed after childhood cancer. As compared with 209 matched controls who had survived cancer in childhood but who did not have bone cancer later, patients who had had radiation therapy had a 2.7-fold risk (95 percent confidence interval, 1.0 to 7.7) and a sharp dose-response gradient reaching a 40-fold risk after doses to the bone of more than 6000 rad. The relative dose-response effect among patients who had been treated for retinoblastoma resembled that among patients with all other types of initial tumors, although the cumulative risk of bone cancer in the retinoblastoma group was higher. Similar numbers of patients were treated with orthovoltage and megavoltage; the patterns of risk among categories of doses did not differ according to the type of voltage. After adjustment for radiation therapy, treatment with alkylating agents was also linked to bone cancer (relative risk, 4.7; 95 percent confidence interval, 1.0 to 22.3), with the risk increasing as cumulative drug exposure rose. We conclude that both radiotherapy and chemotherapy with alkylating agents for childhood cancer increase the subsequent risk of bone cancer.