Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas
Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas
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DOI：
10.1200/jco.1996.14.10.2818
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发表时间：
1996-10-01
影响因子：
45.3
通讯作者：
Kun, LE
中科院分区：
文献类型：
--
作者：
Kuttesch, JF;Wexler, LH;Kun, LE
背景：尤文氏肉瘤的幸存者有发生第二种恶性肿瘤的额外风险。我们研究了一个多机构的数据库，重新评估尤文氏肉瘤的幸存者之间的风险，并确定可能的因果factors.Methods：信息来自一个数据库，其中包括266名尤文氏肉瘤的幸存者。计算继发性恶性肿瘤的累积发生率。评估了临床特征、化疗类型和剂量以及累积放射剂量对继发恶性肿瘤风险的贡献。结果如下：中位随访时间为9.5年后（范围，3.0至30），16例患者发生了第二恶性肿瘤，其中包括10个肉瘤（5例骨肉瘤、3例纤维肉瘤和2例恶性纤维组织细胞瘤）和6例其他恶性肿瘤（急性髓细胞白血病、急性淋巴细胞白血病、脑膜瘤、细支气管肺泡癌、基底细胞癌和宫颈原位癌），诊断为第二种恶性肿瘤的中位潜伏期为7.6年（范围为3.5至25.7年）。20年时任何继发性恶性肿瘤和继发性肉瘤的估计累积发病率分别为9.2%（SD = 2.7%）和6.5%（SD = 2.4%）。继发性肉瘤的累积发病率与辐射剂量有关（P = 0.002）。没有继发性肉瘤的患者谁收到了小于48戈伊，而继发性肉瘤的绝对风险为130例每10,000人-年的观察中的患者谁收到了大于或等于60戈伊.Conclusion：尤文氏肉瘤后的第二恶性肿瘤的总体风险是类似的，与其他儿童癌症的治疗。继发性肉瘤的辐射剂量依赖性证明了治疗中的修改以减少辐射剂量的合理性。(C)1996年，美国临床肿瘤学会。
Background: An excess risk of second malignancies has been reported in survivors of Ewing's sarcoma. We examined a multiinstitutional data base to reevaluate the risk among survivors of Ewing's sarcoma and to identify possible causal factors.Methods: Information was derived from a data base that included 266 survivors of Ewing's sarcoma. Cumulative incidence rates of second malignancies were calculated. Contributions of clinical features, type and dose of chemotherapy, and cumulative radiation dose to the risk of second malignancies were evaluated. Results: After a median follow-up duration of 9.5 years (range, 3.0 to 30), 16 patients have developed second malignancies, which included 10 sarcomas (five osteosarcomas, three fibrosarcomas, and two malignant fibrous histiocytomas) and six other malignancies (acute myeloblastic leukemia, acute lymphoblastic leukemia, meningioma, bronchioalveolar carcinoma, basal cell carcinoma, and carcinoma-in-situ of the cervix), The median latency to the diagnosis of the second malignancy was 7.6 years (range, 3.5 to 25.7). The estimated cumulative incidence rates at 20 years for any second malignancy and for secondary sarcoma were 9.2% (SD = 2.7%) and 6.5% (SD = 2.4%), respectively. The cumulative incidence rate of secondary sarcoma was radiation dose-dependent (P = .002). No secondary sarcomas developed among patients who had received less than 48 Gy, while the absolute risk of secondary sarcoma was 130 cases per 10,000 person-years of observation among patients who had received greater than or equal to 60 Gy.Conclusion: The overall risk of second malignancies after Ewing's sarcomas is similar to that associated with treatment for other childhood cancers. The radiation dose-dependency of secondary sarcomas justifies modification in therapy to reduce radiation doses. (C) 1996 by American Society of Clinical Oncology.