Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries.
Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries.
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DOI：
10.1016/s1470-2045(11)70061-4
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发表时间：
2011-04
期刊：
影响因子：
51.1
通讯作者：
Ron, Elaine
中科院分区：
文献类型：
--
作者：
de Gonzalez, Amy Berrington;Curtis, Rochelle E.;Kry, Stephen F.;Gilbert, Ethel;Lamart, Stephanie;Berg, Christine D.;Stovall, Marilyn;Ron, Elaine
随着癌症生存率的提高，治疗的长期风险，包括放射治疗后发生第二种癌症的风险变得更加重要。可能与放射治疗有关的第二种癌症的比例尚不清楚。我们使用美国监测、流行病学和最终结果癌症登记处对15个常规放疗的癌症部位进行了系统分析。采用Poisson回归法对接受放射治疗的患者与未接受放射治疗的患者的相对风险（RR）进行了估计，并对年龄、分期和其他潜在的混杂因素进行了调整。该队列包括647，672名五年成年幸存者，平均随访7年; 60，271人（9%）发展为第二种实体癌。对于每个第一个癌症部位，与放疗相关的第二个癌症的RR超过1，并且从眼/眼眶癌后的1.08（95%CI：0.79-1.46）到睾丸癌后的1.43（95%CI：1.13-1.84）不等。一般来说，可能接受>5Gy的器官的RR最高，随着诊断时年龄的增加而降低，随着诊断后时间的增加而增加。我们估计总共有3266例（95%CI：2862-3670）可能与放射有关的第二实体癌;占所有放射治疗患者（1+年存活者）总数的8%（95%CI：7%-9%），诊断后15年时每1,000例接受放射治疗的患者中有5例多余癌症。大约一半（54%）的多余癌症发生在可能接受>5Gy的器官中。相对较小比例的第二种癌症与成人的放射治疗有关，这表明大多数是由于其他因素，如生活方式或遗传学。
As cancer survival improves, the long-term risks from treatments including the risk of developing a second cancer after radiotherapy become more important. The proportion of second cancers that may be related to radiotherapy is unknown. We used the U.S. Surveillance, Epidemiology and End Results cancer registries to conduct a systematic analysis of 15 cancer sites that are treated routinely with radiotherapy. Relative risks (RR) for patients receiving radiotherapy versus patients not receiving radiotherapy were estimated using Poisson regression adjusted for age, stage and other potential confounders. The cohort included 647,672 five-year adult survivors followed-up for an average of 7 additional years; 60,271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded one, and varied from 1.08 (95%CI:0.79–1.46) after eye/orbit cancers to 1.43 (95%CI:1.13–1.84) after testicular cancer. In general the RR was highest for organs likely to have received >5Gy, decreased with increasing age at diagnosis and increased with time since diagnosis. We estimated a total of 3266 (95%CI:2862–3670) excess second solid cancers that could be related to radiation; 8% (95%CI:7%–9%) of the total in all radiotherapy patients (1+yr survivors) and 5 excess cancers/1,000 patients treated with radiotherapy by 15 years after diagnosis. Approximately half (54%) the excess cancers were in organs likely to have received >5Gy. A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics.