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在儿童癌症的5年幸存者中治疗和随后的新生体风险的时间趋势,1970-2015
Lucie M Turcotte1, Qi Liu2, Yutaka Yasui3
1University of Minnesota Medical School, Minneapolis.
JAMA
|March 1, 2017
概括
儿童癌症幸存者面临后续瘤的风险增加. 随着时间的推移,放射治疗剂量的时间变化与随后恶性瘤,脑膜瘤和非黑色素瘤皮肤癌的风险降低有关.
科学领域:
- 儿童瘤学
- 癌症生存率
- 辐射瘤学
背景情况:
- 众所周知,包括放射和化疗在内的癌症治疗增加了儿童癌症幸存者的后续瘤风险.
- 这些疗法的时间趋势及其对长期风险的影响尚不清楚.
研究的目的:
- 研究随着时间的推移辐射和化疗剂量变化与儿童癌症幸存者的后续瘤风险之间的关联.
- 量化治疗变化对长期癌症风险的影响.
主要方法:
- 在1970-1999年间诊断的23603名儿童癌症幸存者的回顾性多中心队列研究.
- 随访至2015年12月,分析随后的瘤发病率,累积负担和标准化发病率,按治疗十年划分.
- 多变量模型评估了因人口和临床因素而调整的相对率,并对治疗修改进行了调解分析.
主要成果:
- 放射治疗的使用和中位数从20世纪70年代到90年代显著下降.
- 随后的恶性瘤的累计15年发病率在几十年的治疗期间下降 (从20世纪70年代的2. 1%降至20世纪90年代的1. 3%).
- 减少的辐射剂量与随后恶性瘤 (RR,0. 87),脑膜瘤 (RR,0. 85) 和非黑色素瘤皮肤癌 (RR,0. 75) 的风险较低有关.
结论:
- 虽然在20世纪90年代被诊断为儿童癌症的幸存者仍有随后恶性瘤的风险增加,但与20世纪70年代被诊断为儿童癌症的幸存者相比,这种风险较低.
- 随着时间的推移,治疗辐射剂量的减少与这种风险的降低有关.
- 这些发现凸显了优化放射治疗以减轻癌症幸存者的长期风险的重要性.
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