Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship.
Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship.
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DOI：
10.1016/j.ijrobp.2012.09.001
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发表时间：
2013-06-01
影响因子：
7
通讯作者：
Little, Mark P.
中科院分区：
文献类型：
--
作者：
de Gonzalez, Amy Berrington;Gilbert, Ethel;Curtis, Rochelle;Inskip, Peter;Kleinerman, Ruth;Morton, Lindsay;Rajaraman, Preetha;Little, Mark P.
放射治疗技术的快速创新导致迫切需要高剂量辐射照射引起的第二种癌症风险的风险预测模型，因为直接观察新治疗的后期效应需要对患者进行十年或更长时间的随访。然而，对分次高剂量辐射后的癌症风险模式的了解远不如低剂量照射（0.1-5戈瑞（戈伊））后的癌症风险模式。特别是，在高剂量下剂量-反应曲线的形状以及每单位剂量的第二种癌症风险的大小方面存在不确定性。我们回顾了接受高剂量照射（>5Gy）放射治疗的器官中第二种实体癌的流行病学研究的现有证据，其中剂量-反应曲线是根据个体器官特异性剂量估计的。我们纳入了28项符合条件的研究，其中包括3，434名第二种癌症患者，涉及11种第二种实体癌。总体而言，几乎没有证据表明剂量-反应曲线在风险下降的方向上是非线性的，即使在器官剂量≥ 60 Gy时也是如此。甲状腺癌是唯一的例外，有证据表明在20 Gy后下降。一般来说，在日本原子弹爆炸幸存者中，考虑到年龄和性别，每戈伊的超额相对风险比急性照射<2戈伊的风险低5-10倍。然而，风险降低的幅度因第二种癌症而异。从我们的审查结果提供了从分次高剂量照射辐射致癌的见解，并与目前的理论模型基本一致。研究结果可用于改进新型放射治疗技术的第二实体癌症风险预测模型的开发。
Rapid innovation in radiotherapy techniques has resulted in an urgent need for risk projection models for second cancer risks from high-dose radiation exposure, since direct observation of the late-effects of newer treatments will require patient follow-up for a decade or more. However, the patterns of cancer risk after fractionated high-dose radiation are much less well understood than those after lower-dose exposures (0.1–5 gray (Gy)). In particular, there is uncertainty about the shape of the dose-response curve at high doses, and the magnitude of the second cancer risk per unit dose. We reviewed the available evidence from epidemiologic studies of second solid cancers in organs that received high-dose exposure (>5Gy) from radiotherapy where dose-response curves were estimated from individual organ-specific doses. We included 28 eligible studies with 3,434 second cancer patients across 11 second solid cancers. Overall, there was little evidence that the dose-response curve was non-linear in the direction of a down-turn in risk, even at organ doses of ≥60Gy. Thyroid cancer was the only exception with evidence of a downturn after 20Gy. Generally the excess relative risk per Gy, taking account of age and sex, was 5–10 times lower than the risk from acute exposures of <2Gy among the Japanese atomic bomb survivors. However, the magnitude of the reduction in risk varied according to second cancer. The results from our review provide insights into radiation carcinogenesis from fractionated high-dose exposures, and are generally consistent with current theoretical models. The results can be used to refine the development of second solid cancer risk projection models for novel radiotherapy techniques.
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影响因子：
3.4
作者：
Little, MP;Weiss, HA;Muirhead, CR
通讯作者：
Muirhead, CR
影响因子：
3.4
作者：
Bhatti P;Veiga LH;Ronckers CM;Sigurdson AJ;Stovall M;Smith SA;Weathers R;Leisenring W;Mertens AC;Hammond S;Friedman DL;Neglia JP;Meadows AT;Donaldson SS;Sklar CA;Robison LL;Inskip PD
通讯作者：
Inskip PD
影响因子：
2.6
作者：
Little, MP;Muirhead, CR
通讯作者：
Muirhead, CR
影响因子：
5.7
作者：
Kry, Stephen F.;Salehpour, Mohammad;Followill, David
通讯作者：
Followill, David
DOI：
10.1093/jnci/88.5.270
发表时间：
1996-03-06
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Hawkins, MM;Wilson, LMK;Stovall, MA
通讯作者：
Stovall, MA