Risk of treatment-related esophageal cancer among breast cancer survivors
Risk of treatment-related esophageal cancer among breast cancer survivors
复制标题
DOI：
10.1093/annonc/mds144
复制
发表时间：
2012-12-01
影响因子：
50.5
通讯作者：
Aleman, B. M. P.
中科院分区：
文献类型：
--
作者：
Morton, L. M.;Gilbert, E. S.;Aleman, B. M. P.
乳腺癌的放射治疗可能会使食道暴露于电离辐射，但还没有研究评估乳腺癌后食道癌的风险与辐射剂量或全身治疗的使用有关。对来自五个人群的乳腺癌登记中心(252例，488名单独匹配的对照)的289 748名5年乳腺癌幸存者进行了嵌套病例对照研究，采用个体化放射剂量测量和从医疗记录中提取的信息。食道辐射暴露的最大因素是锁骨上和内乳房链治疗。食道癌的风险随着食道肿瘤部位放射剂量的增加而增加(P-趋势&t；0.001)，剂量为35Gy时，优势比(OR)为8.3.[95%可信区间(CI)2.7-28]。食道癌确诊前5年接受激素治疗的患者风险较低(OR=0.4，95%可信区间0.2~0.8)。根据少数病例，烷化剂化疗似乎不会影响风险。我们的数据与辐射和其他食道癌危险因素(如吸烟)的乘法效应是一致的。食道癌是乳腺癌放射治疗中与辐射剂量相关的并发症，但绝对风险很低。在较高的食道剂量下，这种风险值得在放射治疗风险评估和长期随访中考虑。
Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use.Nested case-control study of esophageal cancer among 289 748 >= 5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records.The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (P-trend < 0.001), with doses of >= 35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy < 5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking).Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.