Bachaud J M, Berthier F, Soulié M, Malavaud B, Plante P, Rischmann P, Chevreau C, Daly-Schveitzer N, Grosclaude P
Département de Radiothérapie, Institut Claudius Regaud, Toulouse, France.
Radiother Oncol. 1999 Feb;50(2):191-7. doi: 10.1016/s0167-8140(98)00101-7.
To measure the incidence of second non-germ cell malignancies (SNGCM) in patients treated for a stage I-II testicular seminoma.
From 1970 to 1992, 131 evaluable patients received in the Institut Claudius Regaud a post-orchiectomy treatment for a stage I-II testicular seminoma. The therapeutic modalities, including salvage treatment for six recurrences, were as follows: infradiaphragmatic radiotherapy (IDRT) (n = 55); infra- and supradiaphragmatic radiotherapy (IDRT + SDRT) (n = 64); IDRT + SDRT with chemotherapy (n = 12). The mean follow-up was 11 years. The cumulative incidence of SNGCM was compared to the overall cancer incidence in the general male population on the basis of the Tarn Cancer Registry; the relative risk was expressed as a standardized incidence ratio (SIR).
Overall, the cumulative incidence of SNGCM was 10.7% (14/131 cases). The SIR was equal to 2.81 (95% confidence interval (CI) 1.54-4.72; P < 0.001) and increased with follow-up duration. The SIR was significantly increased in 64 patients treated with IDRT + SDRT (SIR = 3.08; 95% CI 1.47-5.66; P = 0.002) but not in 55 patients treated with IDRT alone (SIR = 0.62; 95% CI 0.01-3.43; P = 0.8). The 12 patients who received chemotherapy had an SIR of 26.2 (95% CI 5.48-77.69; P < 0.001), while the SIR was 2.26 in the 119 patients who did not receive any chemotherapy (95% CI 1.13-4.04; P = 0.01 ). Of four hematologic malignancies, three appeared in the 12 patients who received chemotherapy.
An increased risk of SNGCM after SDRT + IDRT has been demonstrated. After IDRT alone, the risk of second cancer is not incremented after a median follow-up of 6 years, but further observation of the patients is necessary to achieve final conclusions. Our results suggest that the risk of second cancer and especially of hematologic malignancy is increased by the association of chemotherapy and radiation.
测量接受 I-II 期睾丸精原细胞瘤治疗的患者中第二原发性非生殖细胞恶性肿瘤（SNGCM）的发生率。
1970 年至 1992 年期间，131 例可评估患者在克劳迪乌斯·雷高研究所接受了 I-II 期睾丸精原细胞瘤的睾丸切除术后治疗。治疗方式包括对 6 例复发患者的挽救治疗，具体如下：膈下放疗（IDRT）（n = 55）；膈下和膈上放疗（IDRT + SDRT）（n = 64）；IDRT + SDRT 联合化疗（n = 12）。平均随访时间为 11 年。根据塔尔癌症登记处的数据，将 SNGCM 的累积发生率与一般男性人群的总体癌症发生率进行比较；相对风险以标准化发病率比（SIR）表示。
总体而言，SNGCM 的累积发生率为 10.7%（14/131 例）。SIR 等于 2.81（95%置信区间（CI）1.54 - 4.72；P < 0.001），且随随访时间延长而增加。接受 IDRT + SDRT 治疗的 64 例患者的 SIR 显著升高（SIR = 3.08；95%CI 1.47 - 5.66；P = 0.002），而仅接受 IDRT 治疗的 55 例患者的 SIR 未升高（SIR = 0.62；95%CI 0.01 - 3.43；P = 0.8）。接受化疗的 12 例患者的 SIR 为 26.2（95%CI 5.48 - 77.69；P < 0.001），而未接受任何化疗的 119 例患者的 SIR 为 2.26（95%CI 1.13 - 4.04；P = 0.01）。在 4 例血液系统恶性肿瘤中，有 3 例出现在接受化疗的 12 例患者中。
已证实 SDRT + IDRT 后 SNGCM 的风险增加。单独接受 IDRT 治疗后，经过 6 年的中位随访，第二原发性癌症的风险未增加，但需要对患者进行进一步观察以得出最终结论。我们的结果表明，化疗与放疗联合可增加第二原发性癌症尤其是血液系统恶性肿瘤的风险。
