Malignant breast tumors after radiotherapy for a first cancer during childhood
Malignant breast tumors after radiotherapy for a first cancer during childhood
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DOI：
10.1200/jco.2005.06.225
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发表时间：
2005-01-01
影响因子：
45.3
通讯作者：
de Vathaire, F
中科院分区：
文献类型：
--
作者：
Guibout, C;Adjadj, E;de Vathaire, F
目的评估儿童癌症幸存者中治疗和首发癌（FC）类型在长期后续乳腺癌（BC）风险中的具体作用。患者和方法在1946年至1986年期间，在法国和英国的8个中心接受治疗的1814名3岁女性幸存者中，收集了化疗和放疗的数据。对1,258例接受外部放射治疗的患者进行了每个乳房的辐射剂量的个人估计；对乳腺的平均剂量为5.06 Gy（范围，0.0 ~ 88.0 Gy），分20次（平均）递送。结果平均随访16年；16例患者发生临床BC， 13例放疗后发生。FC后30年BC的累积发病率为2.8% (95% CI, 1.0% - 4.5%)， 40岁时为5.1% （95% CI, 2.1% - 8.2%）。年超额发病率随着年龄的增长而增加，而标准化发病率呈下降趋势。平均而言，任何乳房接受的每一个Gray单位使BC的超额相对风险增加0.13（< 0.0至0.75）。在阉割和达到的年龄进行分层，并根据辐射剂量、FC类型和化疗进行调整后，随后发生BC的高风险与霍奇金病相关（相对风险7.0;95% CI 1.4至30.9）。结论报告的儿童霍奇金病治疗后BC的高风险似乎不仅是由于乳房放射剂量较高，而且是由于特定的易感性。
Purpose To assess the specific role of treatment and type of first cancer (FC) in the risk of long-term subsequent breast cancer (BC) among childhood cancer survivors.Patients and Methods In a cohort of 1,814 3-year female survivors treated between 1946 and 1986 in eight French and English centers, data on chemotherapy and radiotherapy were collected. Individual estimation of radiation dose to each breast was performed for the 1,258 patients treated by external radiotherapy; mean dose to breast was 5.06 Gy (range, 0.0 to 88.0 Gy) delivered in 20 fractions (mean).Results Mean follow-up was 16 years; 16 patients developed a clinical BC, 13 after radiotherapy. The cumulative incidence of BC was 2.8% (95% CI, 1.0% to 4.5%) 30 years after the FC and 5.1% (95% CI, 2.1% to 8.2%) at the age of 40 years. The annual excess incidence increased as age increased, whereas the standardized incidence ratio decreased. On average, each Gray unit received by any breast increased the excess relative risk of BC by 0.13 (< 0.0 to 0.75). After stratification on castration and attained age, and adjusting for radiation dose, FC type, and chemotherapy, a higher risk of a subsequent BC was associated with Hodgkin's disease (relative risk, 7.0; 95% CI, 1.4 to 30.9).Conclusion The reported high risk of BC after childhood Hodgkin's disease treatment seems to be due not only to a higher radiation dose to the breasts, but also to a specific susceptibility.