Department of Epidemiology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Radiat Res. 2010 Dec;174(6):840-50. doi: 10.1667/RR1903.1. Epub 2010 Sep 17.
In the last four decades, advances in therapies for primary cancers have improved overall survival for childhood cancer. Currently, almost 80% of children will survive beyond 5 years from diagnosis of their primary malignancy. These improved outcomes have resulted in a growing population of childhood cancer survivors. Radiation therapy, while an essential component of primary treatment for many childhood malignancies, has been associated with risk of long-term adverse outcomes. The Childhood Cancer Survivor Study (CCSS), a retrospective cohort of over 14,000 survivors of childhood cancer diagnosed between 1970 and 1986, has been an important resource to quantify associations between radiation therapy and risk of long-term adverse health and quality of life outcomes. Radiation therapy has been associated with increased risk for late mortality, development of second neoplasms, obesity, and pulmonary, cardiac and thyroid dysfunction as well as an increased overall risk for chronic health conditions. Importantly, the CCSS has provided more precise estimates for a number of dose-response relationships, including those for radiation therapy and development of subsequent malignant neoplasms of the central nervous system, thyroid and breast. Ongoing study of childhood cancer survivors is needed to establish long-term risks and to evaluate the impact of newer techniques such as conformal radiation therapy or proton-beam therapy.
在过去的四十年中，原发性癌症治疗方法的进步提高了儿童癌症的总体生存率。目前，近 80%的儿童在被诊断出原发性恶性肿瘤后 5 年以上的时间内能够存活。这些改善的结果导致了儿童癌症幸存者人数的不断增加。放射治疗虽然是许多儿童恶性肿瘤的主要治疗方法之一，但与长期不良后果的风险有关。儿童癌症幸存者研究（CCSS）是一个回顾性队列研究，包含了 1970 年至 1986 年间诊断出的超过 14000 名儿童癌症幸存者，该研究是量化放射治疗与长期不良健康和生活质量结果之间关联的重要资源。放射治疗与晚期死亡率、第二肿瘤形成、肥胖、肺、心脏和甲状腺功能障碍以及总体慢性健康状况风险增加有关。重要的是，CCSS 为许多剂量反应关系提供了更精确的估计，包括放射治疗与中枢神经系统、甲状腺和乳腺随后发生恶性肿瘤的关系。需要对儿童癌症幸存者进行持续研究，以确定长期风险，并评估新的技术（如适形放射治疗或质子束治疗）的影响。
