Lavey R S, Eby N L, Prosnitz L R
Department of Radiation Oncology, UCLA Center for Health Sciences 90024.
Cancer. 1990 Jul 1;66(1):80-8. doi: 10.1002/1097-0142(19900701)66:1<80::aid-cncr2820660116>3.0.co;2-9.
The risk of a second malignancy was determined for 999 patients given primary treatment using chemotherapy only, radiation therapy only, or both for Hodgkin's Disease or a non-Hodgkin's lymphoma at Duke University Medical Center between 1970 and 1981. The incidence, 10-year actuarial risk, and relative risk of developing an acute leukemia, solid tumor, or second lymphoma were determined by treatment modality and initial lymphoma type. Among the 313 Hodgkin's disease patients, the acute leukemia actuarial risk was 2.0% after chemotherapy, 1.4% after radiation therapy, and 0.9% after combined treatment with chemotherapy and radiation therapy. Their relative risk for acute leukemia was 51.3 overall (95% confidence interval [CI] 13.8 to 131.8) and was elevated in each treatment group. Among the 686 non-Hodgkin's lymphoma patients, the acute leukemia actuarial risk was zero after radiation therapy, 4.6% after chemotherapy, and 4.5% after the combined treatment, again not significantly different between treatment groups. The leukemia relative risk was 10.6 (95% CI 3.4 to 24.8) in the chemotherapy and 11.9 (95% CI 3.2 to 30.6) in the combined treatment group. Among both the Hodgkin's disease and non-Hodgkin's lymphoma populations, the combined treatment group had a lower actuarial risk for solid tumors than either the chemotherapy or radiation therapy group (P less than 0.02). Solid tumor actuarial risk did not differ significantly between the chemotherapy and radiation therapy groups. Hodgkin's disease patients had a solid tumor relative risk that was elevated significantly after radiation therapy (6.5; 95% CI 2.4 to 14.0) and to a lesser extent after chemotherapy (2.6; 95% CI 0.8 to 6.1) or combined treatment (1.7; 95% CI 0.2 to 6.0). Solid tumor relative risk among non-Hodgkin's lymphoma patients was 0.3 for the combined treatment, 0.8 for the chemotherapy, and 1.0 for the radiation therapy group. None of the Hodgkin's disease patients developed a non-Hodgkin's lymphoma. This study found no significant difference in leukemia risk among lymphoma patients treated with chemotherapy and the combined treatment. It also found that the overall risk of a second malignancy is no higher after treatment with the combined therapy than with chemotherapy or radiation therapy alone.
1970年至1981年间，在杜克大学医学中心，对999例仅接受化疗、仅接受放疗或两者皆用进行原发性治疗的霍奇金病或非霍奇金淋巴瘤患者，测定了发生第二种恶性肿瘤的风险。根据治疗方式和初始淋巴瘤类型，确定了发生急性白血病、实体瘤或第二种淋巴瘤的发病率、10年精算风险和相对风险。在313例霍奇金病患者中，化疗后急性白血病精算风险为2.0%，放疗后为1.4%，化疗与放疗联合治疗后为0.9%。他们急性白血病的总体相对风险为51.3（95%置信区间[CI]13.8至131.8），且在每个治疗组中均升高。在686例非霍奇金淋巴瘤患者中，放疗后急性白血病精算风险为零，化疗后为4.6%，联合治疗后为4.5%，治疗组之间同样无显著差异。化疗组白血病相对风险为l0.6（95%CI3.4至24.8），联合治疗组为11.l9（95%CI3.2至30.6）。在霍奇金病和非霍奇金淋巴瘤人群中，联合治疗组实体瘤的精算风险均低于化疗组或放疗组（P<0.02）。化疗组和放疗组实体瘤精算风险无显著差异。霍奇金病患者放疗后实体瘤相对风险显著升高（6.5；95%CI2.4至14.0），化疗后（2.6；95%CI0.8至6.1）或联合治疗后（1.7；95%CI0.2至6.0）升高程度较小。非霍奇金淋巴瘤患者联合治疗组实体瘤相对风险为0.3，化疗组为0.8，放疗组为1.0。没有霍奇金病患者发生非霍奇金淋巴瘤。本研究发现，化疗和联合治疗的淋巴瘤患者白血病风险无显著差异。还发现联合治疗后发生第二种恶性肿瘤的总体风险并不高于单独化疗或放疗。
