Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Cancer. 2010 May 15;116(10):2486-92. doi: 10.1002/cncr.25067.
Although several studies had examined secondary malignancies in patients with specific primary tumor types, to the authors' knowledge there are very few data examining the long-term sequelae of pelvic radiation as a whole. The goal of the current study was to examine the risk of treatment-associated leukemia and multiple myeloma in patients treated with pelvic radiotherapy.
Patients with invasive tumors of the vulva, cervix, uterus, anus, and rectosigmoid treated from 1973 to 2005 and recorded in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients were stratified based on receipt of pelvic radiotherapy. The incidence of secondary leukemia (except chronic lymphocytic leukemia) and multiple myeloma were examined. Multivariate Cox proportional hazards models and Kaplan-Meier curves were constructed to examine the association between pelvic radiation and the development of subsequent hematologic malignancies.
A total of 199,268 individuals, including 66,896 (34%) who received pelvic radiotherapy and 132,372 (66%) not treated with radiation, were identified. In a Cox proportional hazards model adjusting for other risk factors, post-treatment leukemia was increased by 72% (hazard ratio [HR], 1.72; 95% confidence interval [95% CI], 1.37-2.15) in the patients who received pelvic radiotherapy. The risk of secondary leukemia peaked at 5 to 10 years after primary treatment (HR, 1.85; 95% CI, 1.40-2.44) and remained elevated even 10 to 15 years after initial treatment (HR, 1.50; 95% CI, 1.03-2.18). There was no significant association between radiation and the development of multiple myeloma (HR, 1.08; 95% CI, 0.81-1.44).
Pelvic radiation was associated with an increased risk of secondary leukemia but did not appear to increase the risk of multiple myeloma.
尽管有几项研究检查了特定原发性肿瘤类型患者的继发性恶性肿瘤，但据作者所知，几乎没有数据检查整个骨盆放疗的长期后果。本研究的目的是检查接受骨盆放疗的患者治疗相关白血病和多发性骨髓瘤的风险。
分析了 1973 年至 2005 年期间在监测、流行病学和最终结果（SEER）数据库中记录的外阴、宫颈、子宫、肛门和直肠肿瘤侵袭性肿瘤患者。患者根据接受骨盆放疗进行分层。检查继发性白血病（慢性淋巴细胞白血病除外）和多发性骨髓瘤的发病率。构建多变量 Cox 比例风险模型和 Kaplan-Meier 曲线，以检查骨盆放疗与随后发生血液系统恶性肿瘤之间的关联。
共纳入 199268 人，其中 66896 人（34%）接受了骨盆放疗，132372 人（66%）未接受放疗。在调整其他危险因素的 Cox 比例风险模型中，接受骨盆放疗的患者治疗后白血病的风险增加了 72%（风险比 [HR]，1.72；95%置信区间 [95%CI]，1.37-2.15）。继发性白血病的风险在原发治疗后 5 至 10 年达到高峰（HR，1.85；95%CI，1.40-2.44），甚至在初始治疗后 10 至 15 年仍保持升高（HR，1.50；95%CI，1.03-2.18）。放射治疗与多发性骨髓瘤的发生无显著相关性（HR，1.08；95%CI，0.81-1.44）。
骨盆放疗与继发性白血病的风险增加相关，但似乎不会增加多发性骨髓瘤的风险。
