霍奇金病后发生乳腺癌：临床病理特征、治疗和结局：214 例分析。
Breast cancer occurred after Hodgkin's disease: clinico-pathological features, treatments and outcome: analysis of 214 cases.
机构信息
Radiation Oncology Department, Polyclinique de Courlancy, 38 rue de Courlancy, 51100 Reims, France.
出版信息
Crit Rev Oncol Hematol. 2012 Jan;81(1):29-37. doi: 10.1016/j.critrevonc.2011.01.005. Epub 2011 Feb 17.
BACKGROUND
Secondary tumours (ST) represent a major concern in survivors of Hodgkin's disease (HD). Breast cancer (BC) is the most frequent ST among young treated women.
MATERIAL AND METHODS
One hundred and eighty-nine women treated for HD by radiotherapy (RT) and/or chemotherapy (CT) subsequently developed 214 BCs.
RESULTS
Median age at HD diagnosis was 25 years (34% were less than 20). Median interval between HD and BC was 18.6 years, with a 42-year median age at first BC. According to the TNM classification, there were 30 (14%) T0 (non palbable lesions), 86 (40%) T1, 56 (26%) T2, 13 (6%) T3T4 and 29 (14%) Tx. There were 25 (13.2%) contralateral BC. 160 (75%) and 15 (7%) tumours were infiltrating ductal and lobular carcinomas, 7 (3.3%) were other subtypes and 27 (22%) DCIS. The rate of axillary nodal involvement was 32%. Among 203 operated tumours, 79 (39%) were treated by breast conserving surgery (BCS), with RT in 56 (71%) cases. CT and hormonal treatment were delivered in 51% and 45% of the patients. With a 50-month median follow-up, local recurrence occurred in 12% of the tumours (9% after mastectomy, 21% after lumpectomy alone and 13.7% after lumpectomy with RT). Metastasis occurred in 47 (26%) patients. The risk factors were pN+, pT, high SBR grade and young age (< 50 years). The ten-year overall and specific survival rates were 53% and 63.5%, respectively. The ten-year specific survival rates were 79% for pT0T1T2, 48% for pT3T4 (p = 0.0002) and 79% for pN0 versus 38.5% for pN+ (p = 0.00026). Among 67 deaths, 43 (73%) were due to BC.
CONCLUSION
Patients and physicians should be aware that BC is the most frequent secondary tumour in young women treated for HD. The new RT modalities (lower doses and involved fields) may decrease the risk in the future. However, these women require a careful monitoring as from 8 to 10 years after HD treatment, combining mammography, ultrasound and MRI according to several ongoing studies. BC with whole breast irradiation is feasible in some selected cases.
背景
继发性肿瘤（ST）是霍奇金病（HD）幸存者的主要关注点。乳腺癌（BC）是接受治疗的年轻女性中最常见的继发性肿瘤。
材料和方法
189 名接受放疗（RT）和/或化疗（CT）治疗的 HD 患者随后发展为 214 例 BC。
结果
HD 诊断时的中位年龄为 25 岁（34%的患者小于 20 岁）。HD 与 BC 之间的中位间隔为 18.6 年，首次 BC 的中位年龄为 42 岁。根据 TNM 分类，有 30 例（14%）为 T0（不可触及病变），86 例（40%）为 T1，56 例（26%）为 T2，13 例（6%）为 T3T4，29 例（14%）为 Tx。有 25 例（13.2%）为对侧 BC。160 例（75%）和 15 例（7%）为浸润性导管癌和小叶癌，7 例（3.3%）为其他亚型，27 例（22%）为 DCIS。腋窝淋巴结受累率为 32%。在 203 例接受手术的肿瘤中，79 例（39%）采用保乳手术（BCS）治疗，其中 56 例（71%）接受了放射治疗。51%和 45%的患者接受了 CT 和激素治疗。在中位随访 50 个月时，12%的肿瘤发生局部复发（乳房切除术 9%，单纯乳房切除术 21%，乳房切除术联合放疗 13.7%）。47 例（26%）患者发生转移。危险因素为 pN+、pT、高 SBR 分级和年轻（<50 岁）。总生存率和特定生存率分别为 53%和 63.5%。pT0T1T2 的 10 年特定生存率为 79%，pT3T4 为 48%（p=0.0002），pN0 为 79%，pN+为 38.5%（p=0.00026）。在 67 例死亡中，43 例（73%）死于 BC。
结论
患者和医生应意识到，BC 是接受 HD 治疗的年轻女性中最常见的继发性肿瘤。新的放疗方式（低剂量和受累野）可能会降低未来的风险。然而，这些女性需要从 HD 治疗后 8 至 10 年开始进行仔细监测，根据几项正在进行的研究，结合乳房 X 线照相术、超声和 MRI 进行监测。对于某些选定的病例，全乳照射联合 BC 是可行的。
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