2ND MALIGNANT NEOPLASMS FOLLOWING TREATMENT FOR WILMS-TUMOR - A REPORT FROM THE NATIONAL WILMS-TUMOR STUDY-GROUP
2ND MALIGNANT NEOPLASMS FOLLOWING TREATMENT FOR WILMS-TUMOR - A REPORT FROM THE NATIONAL WILMS-TUMOR STUDY-GROUP
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DOI：
10.1200/jco.1995.13.8.1851
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发表时间：
1995-08-01
影响因子：
45.3
通讯作者：
GREEN, DM
中科院分区：
文献类型：
--
作者：
BRESLOW, NE;TAKASHIMA, JR;GREEN, DM
目的：本研究旨在确定肾母细胞瘤治疗患者继发恶性肿瘤（SMNs）的发生率，并说明其发生率如何随初始治疗方案而变化。在1969年10月至1991年12月期间，5，278名可评估的患者参加了国家Wilms肿瘤研究（NWTS），到1993年底，461人年随访研究。第二个癌症的预期人数计算通过应用国家发病率的人年按年龄，性别和日历年分类year.Results：43 SMN进行了观察，而只有5.1预期（标准化发病率比[SIR]，8.4; 95%置信区间[CI]，6.1至11.4）。肾母细胞瘤诊断后15年，SMN的累积发病率为1.6%，并稳步上升。作为初始治疗的一部分接受的腹部放疗增加了SMN的风险（SIR，1.43/10戈伊; 95% CI，1.13 - 1.81）。多柔比星增强辐射效应。在234例接受多柔比星和大于35戈伊腹部放疗的患者中，观察到8例SMN，而预期仅为0.22例（SIR，36; 95% CI，16 - 72）。复发的治疗进一步增加SMN的风险4至5倍。结论：这些结果表明，目前的努力，以限制使用强化化疗和放疗的重要性，现在只适用于最积极的疾病的患者。继续密切监测绝大多数长期存活的肾母细胞瘤患者对于SMN的早期诊断和治疗的其他晚期后遗症是必不可少的。J Clin Oncol 13：1851-1859。(C)1995年，美国临床肿瘤学会。
Purpose: The study was undertaken to determine the incidence of second malignant neoplasms (SMNs) in patients treated for Wilms' tumor and demonstrate how the incidence varied with the initial treatment protocol.Patients and Methods: Between October 1969 and December 1991, 5,278 assessable patients were enrolled onto the National Wilms' Tumor Study (NWTS) and by the end of 1993 had contributed 39,461 person-years to a follow-up study. Expected numbers of second cancers were calculated by applying national incidence rates to person-years classified by age, sex, and calendar year.Results: Forty-three SMNs were observed, whereas only 5.1 were expected (standardized incidence ratio [SIR], 8.4; 95% confidence interval [CI], 6.1 to 11.4). Fifteen years after the Wilms' tumor diagnosis, the cumulative incidence of a SMN was 1.6% and increasing steadily. Abdominal irradiation received as part of the initial therapy increased the risk of a SMN (SIR, 1.43/10 Gy; 95% CI, 1.13 to 1.81). Doxorubicin potentiated the radiation effect. Among 234 patients who received doxorubicin and greater than 35 Gy of abdominal radiation, eight SMNs were observed, whereas only 0.22 were expected (SIR, 36; 95% CI, 16 to 72). Treatment for relapse further increased the SMN risk by a factor of 4 to 5.Conclusion: These results demonstrate the importance of current efforts to limit the use of intensive chemotherapy and radiation therapy, which are now applied only to patients with the most aggressive disease. Continuing close surveillance of the great majority of Wilms' tumor patients who become long-term survivors is essential for early diagnosis of SMNs and other late sequelae of therapy.J Clin Oncol 13:1851-1859. (C) 1995 by American Society of Clinical Oncology.