Smith L M, Donaldson S S
Department of Radiation Oncology, Stanford University Medical Center.
Oncology (Williston Park). 1991 May;5(5):135-41; discussion 142, 147-8.
Childhood cancer survivors at highest risk of developing a secondary malignancy are those with hereditary retinoblastoma. The majority of such secondary cancers will be sarcomas, most commonly of bone. One-third of these occur outside a typical radiation field, commonly in an extremity. Bone sarcoma is also the most commonly reported secondary cancer to develop among survivors of Ewing's sarcoma. In this group, radiation doses greater than 60 Gy as well as alkylating agent chemotherapy have been identified as contributors to the increased risk. The prognosis for patients with a secondary sarcoma has been poor, with few cures reported to date. However, an aggressive, combined modality approach, including radical resection, postoperative radiation, and adjuvant chemotherapy, may improve the survival rate.
患继发性恶性肿瘤风险最高的儿童癌症幸存者是那些患有遗传性视网膜母细胞瘤的患者。这类继发性癌症大多为肉瘤，最常见的是骨肉瘤。其中三分之一发生在典型放疗区域之外，通常在四肢。骨肉瘤也是尤因肉瘤幸存者中最常报告发生的继发性癌症。在这组患者中，已确定辐射剂量大于60 Gy以及烷化剂化疗是导致风险增加的因素。继发性肉瘤患者的预后一直很差，迄今为止报告的治愈病例很少。然而，一种积极的综合治疗方法，包括根治性切除、术后放疗和辅助化疗，可能会提高生存率。
