Cardiovascular death and second non-breast cancer malignancy after postmastectomy radiation and doxorubicin-based chemotherapy
Cardiovascular death and second non-breast cancer malignancy after postmastectomy radiation and doxorubicin-based chemotherapy
复制标题
DOI：
10.1016/s0360-3016(03)00594-7
复制
发表时间：
2003-10-01
影响因子：
7
通讯作者：
Buchholz, TA
中科院分区：
文献类型：
--
作者：
Woodward, WA;Strom, EA;Buchholz, TA
目的：为了评估乳腺切除术后放射和阿霉素为基础的辅助化疗后的长期毒性的发病率。方法：回顾性分析了470例乳腺切除术，阿霉素为基础的化疗和乳腺切除术后放射治疗的患者在5个机构的前瞻性试验的记录。将精算毒性率与1031名接受乳房切除术和阿霉素化疗但未接受乳房切除术后放疗的患者进行比较。对于那些接受放射治疗的患者，胸壁接受的中位剂量为55戈伊，其中钴-60（42%）或电子（51%）。辅助化疗包括多柔比星为基础的方案，通常随后2年的环磷酰胺，甲氨蝶呤，氟尿嘧啶。结果：平均随访时间为10年。放疗后10年总的RTOG毒性分级>1和≥ 3的精算率分别为4%和2%。第二种非乳腺癌恶性肿瘤的总体10年和15年精算率分别为3.8%和7%。在接受辐射和未接受辐射的队列中，非乳腺癌继发性恶性肿瘤的发生率无统计学差异（10年精算发生率分别为3.4%和4.7%）。年龄增加和化疗周期>10个与第二恶性肿瘤发生率较高相关（p = 0.025，p = 0.016）。10年心肌梗死（MI）死亡的精算率分别为2.4%（8起事件）和0.5%（5起事件），在辐射组和未辐射组（p = 0.058）。在8例死于心肌梗死的放射治疗患者中，2例左侧乳腺癌。结论：我们发现乳腺切除术后放射治疗的严重后遗症发生率非常低，包括心肌梗死和非乳腺癌继发恶性肿瘤死亡。在接受>10个周期的含环磷酰胺化疗的患者中，第二次非乳腺癌恶性肿瘤的发生率增加。(C)2003年爱思唯尔公司
Purpose: To assess the incidence of long-term toxicity after postmastectomy radiation and doxorubicin-based adjuvant chemotherapy.Methods: Records of 470 patients treated with mastectomy, doxorubicin-based chemotherapy, and postmastectomy radiation in five institutional prospective trials were retrospectively reviewed. Actuarial toxicity rates were compared with those of 1031 patients treated with mastectomy and doxorubicin-based chemotherapy who did not receive postmastectomy radiation. For those treated with radiation, the chest wall received a median dose of 55 Gy with Co-60 (42%) or electrons (51%). Adjuvant chemotherapy consisted of a doxorubicin-based regimen, often followed by 2 years of cyclophosphamide, methotrexate, and fluorouracil.Results: Median follow-up was 10 years. The overall 10-year actuarial rates of RTOG toxicity Grade >1 and greater than or equal to3 after radiation were 4% and 2%, respectively. The overall 10- and 15-year actuarial rates of second non-breast cancer malignancy were 3.8% and 7%, respectively. There was no statistical difference between the rates of non-breast cancer second malignancy in the radiated and unirradiated cohorts (3.4% vs. 4.7% 10-year actuarial rates). Increasing age and treatment with >10 cycles of chemotherapy were associated with higher rates of second malignancy (p = 0.025, p = 0.016). The 10-year actuarial rate of death from myocardial infarction (MI) was 2.4% (eight events) and 0.5% (five events) in the radiated and unirradiated groups, respectively (p = 0.058). Of the 8 irradiated patients who died of MI, 2 patients had left-sided breast cancer.Conclusions: We found very low rates of serious sequelae after postmastectomy radiation, including death from myocardial infarction and non-breast cancer second malignancy. The rate of second non-breast cancer malignancy was increased among patients treated with >10 cycles of cyclophosphamide-containing chemotherapy. (C) 2003 Elsevier Inc.