Menu-Branthomme Axelle, Rubino Carole, Shamsaldin Akhtar, Hawkins Michael M, Grimaud Emmanuel, Dondon Marie-Gabrielle, Hardiman Claire, Vassal Gilles, Campbell Sarah, Panis Xavier, Daly-Schveitzer Nicolas, Lagrange Jean-Leon, Zucker Jean-Michel, Chavaudra Jean, Hartman Olivier, de Vathaire Florent
National Institute of Public Health and Medical Research, Unit XUR521, Gustave Roussy Institute, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
Int J Cancer. 2004 May 20;110(1):87-93. doi: 10.1002/ijc.20002.
Soft tissue sarcoma (STS) is one of the most frequent second primary cancer that occurs during the first 20 years following treatment for a solid cancer in childhood. Our aim was to quantify the risk of STS as a second malignant neoplasm and to investigate its relationship with radiotherapy and chemotherapy. A cohort study of 4,400 3-year survivors of a first solid cancer diagnosed during childhood in France or the United Kingdom, between 1942 and 1985, was followed 15 years on average. In a partially nested case-control study, we matched 25 cases of STS and 121 controls for sex, type of first cancer, age at first cancer and duration of follow-up. Sixteen STS occurred in the cohort, as compared to 0.3 expected from the general population (Standardized Incidence Radio, SIR = 54 (95%CI: 34-89)). The SIR was 113 (95% CI: 62-185) after chemotherapy plus radiotherapy (13 STS), whereas it was 28 (95%CI: 2-125) after chemotherapy alone (1 STS) and 19 (95%CI: 3-60) after radiotherapy alone (2 STS). After adjustment for treatment, there was no evidence of variation in the annual excess of incidence or in the SIR with either age at first cancer or time since 1st cancer. In the case-control study, the risk of a STS was increased with the square of the dose of radiation to the site of STS development and with the administration of Procarbazine. The increased risk of soft tissue sarcoma that occurred after childhood cancer is independently related to exposure to radiotherapy and Procarbazine. A closer surveillance of children treated with this treatment combination is strongly recommended.
软组织肉瘤（STS）是儿童实体癌治疗后最初20年内最常见的第二原发性癌症之一。我们的目的是量化STS作为第二恶性肿瘤的风险，并研究其与放疗和化疗的关系。对1942年至1985年间在法国或英国诊断出的首例实体癌的4400名3年幸存者进行了队列研究，平均随访15年。在一项部分嵌套的病例对照研究中，我们为25例STS病例和121例对照匹配了性别、首例癌症类型、首例癌症时的年龄和随访时间。队列中出现了16例STS，而从一般人群预期为0.3例（标准化发病率比，SIR = 54（95%CI：34 - 89））。化疗加放疗后（13例STS）SIR为113（95%CI：62 - 185），而单独化疗后（1例STS）为28（95%CI：2 - 125），单独放疗后（2例STS）为19（95%CI：3 - 60）。在对治疗进行调整后，没有证据表明首例癌症时的年龄或自首例癌症以来的时间与年度发病率超额或SIR存在差异。在病例对照研究中，STS的风险随着STS发生部位的辐射剂量平方以及丙卡巴肼的使用而增加。儿童癌症后发生的软组织肉瘤风险增加与放疗和丙卡巴肼暴露独立相关。强烈建议对接受这种治疗组合的儿童进行更密切的监测。
