Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300 000 women in US SEER cancer registries
Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300 000 women in US SEER cancer registries
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DOI：
10.1016/s1470-2045(05)70251-5
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发表时间：
2005-08-01
期刊：
影响因子：
51.1
通讯作者：
Peto, R
中科院分区：
文献类型：
--
作者：
Darby, SC;McGale, P;Peto, R
背景早期乳腺癌的放射治疗可以降低乳腺癌死亡率，但增加其他死亡率，主要是心脏病和肺癌。左侧乳腺癌照射的平均心脏剂量可能是右侧乳腺癌的两到三倍。平均同侧（即与乳腺癌同侧）肺剂量也可能是平均对侧肺剂量的2倍或3倍。特别是在20世纪70年代，当典型的心脏和肺照射大于现在时，照射乳腺癌的偏侧性可能会显著影响心脏死亡率和数十年后右肺或左肺癌症的死亡率。本研究的目的是从常规的癌症登记和死亡证明数据中评估美国普通人群中的危险性。方法我们分析了308861例已知偏侧性早期乳腺癌的美国妇女的数据1973-2001年期间在美国监测流行病学和最终结果（SEER）癌症登记处登记并前瞻性随访病因的患者（左侧或右侧）结果115165例（37%）接受放射治疗。在那些没有的人中，肿瘤的偏侧性与随后的死亡率几乎没有相关性。对于1973-82年诊断并接受放射治疗的女性，心脏死亡率（左与右肿瘤偏侧性）在10年内为1.20（95% CI 1.04-1.38），10-14年后为1.42（1.11-1.82），15年或更长时间后为1.58（1.29-1.95）（趋势：2 p =0.03）。在1983-92年诊断并接受放射治疗的妇女中，10年内心脏病死亡率为1.04（0.91-1.18），10年或10年以上为1.27（0.99-1.63）。在1993-2001年期间诊断并接受放射治疗的妇女的心脏病死亡率为0.96（0.82-1.12），10年内没有随访。在因乳腺癌接受放射治疗的妇女中，随后患上同侧或对侧肺癌的，在1973-82年诊断并接受过放射治疗的妇女中，（0.62-2.19），2.00（1.00-4.00）和2.71（1.65-4.48），分别为小于10年，10-14年和15年或更长时间后（趋势：2 p =0.04）。对于1982年以后接受放射治疗的妇女，迄今为止，关于10年以上肺癌风险的信息很少。20世纪70年代和80年代初的美国乳腺癌放射治疗方案在10-20年后明显增加了心脏病和肺癌的死亡率，但迄今为止，关于20多年后的危害的直接证据很少。自20世纪80年代初以来，放射治疗计划的改进本应减少此类风险，但仍需直接监测各国普通人群的长期危害。
Background Radiotherapy for early breast cancer can decrease breast cancer mortality but increase other mortality, mainly from heart disease and lung cancer. The mean cardiac dose from irradiation of a left-sided breast cancer can be two or three times that for a right-sided breast cancer. The mean ipsilateral (ie, on the same side as the breast cancer) lung dose can also be two or three times the mean contralateral lung dose. Particularly during the 1970s, when typical heart and lung exposures were greater than now, the laterality of an irradiated breast cancer could measurably affect cardiac mortality and mortality from cancer of the right or the left lung decades later. This study aimed to assess the hazards in the general US population from routine cancer-registry and death-certificate data.Methods We analysed data for 308 861 US women with early breast cancer of known laterality (left-sided or right-sided) who were registered in the US Surveillance Epidemiology and End Results (SEER) cancer registries during 1973-2001 and followed prospectively for cause-specific mortality until Jan 1, 2002.Findings 115 165 (37%) received radiotherapy. Among those who did not, tumour laterality was of little relevance to subsequent mortality. For women diagnosed during 1973-82 and irradiated, the cardiac mortality ratio (left versus right tumour laterality) was 1.20 (95% CI 1.04-1.38) less than 10 years afterwards, 1.42 (1.11-1.82) 10-14 years afterwards, and 1.58 (1.29-1.95) after 15 years or more (trend: 2p=0.03). For women diagnosed during 1983-92 and irradiated, the cardiac mortality ratio was 1.04 (0.91-1.18) less than 10 years afterwards and 1.27 (0.99-1.63) 10 or more years afterwards. For women diagnosed during 1993-2001 and irradiated the cardiac mortality ratio was 0.96 (0.82-1.12), with none yet followed for 10 years. Among women irradiated for breast cancer who subsequently developed an ipsilateral or contralateral lung cancer, the lung cancer mortality ratio (ipsilateral versus contralateral) for women diagnosed during 1973-82 and irradiated was 1.17 (0.62-2.19), 2.00 (1.00-4.00), and 2.71 (1.65-4.48), respectively, less than 10 years, 10-14 years, and 15 or more years afterwards (trend: 2p=0.04). For women irradiated after 1982 there is, as yet, little information on lung cancer risks more than 10 years afterwards.Interpretation US breast cancer radiotherapy regimens of the 1970s and early 1980s appreciably increased mortality from heart disease and lung cancer 10-20 years afterwards with, as yet, little direct evidence on the hazards after more than 20 years. Since the early 1980s, improvements in radiotherapy planning should have reduced such risks, but the long-term hazards in the general populations of various countries still need to be monitored directly.