Finke Isabelle, Scholz-Kreisel Peter, Hennewig Ulrike, Blettner Maria, Spix Claudia
German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, 55101, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, 55101, Germany.
Radiat Oncol. 2015 Oct 31;10:219. doi: 10.1186/s13014-015-0521-6.
Radiotherapy is associated with a risk of subsequent neoplasms (SN) in childhood cancer survivors. It has been shown that children's thyroid glands are especially susceptible. The aim is to quantify the risk of a second neck neoplasm after primary cancer radiotherapy with emphasis on thyroid cancer.
We performed a nested case-control study: 29 individuals, diagnosed with a solid SN in the neck region, including 17 with thyroid cancer, in 1980-2002 and 57 matched controls with single neoplasms were selected from the database of the German Childhood Cancer Registry. We investigated the risk associated with radiotherapy exposure given per body region, adjusted for chemotherapy.
16/17 (94.1 %) thyroid SN cases, 9/12 (75 %) other neck SN cases and 34/57 (59.6 %) controls received radiotherapy, with median doses of 27.8, 25 and 24 Gy, respectively. Radiotherapy exposure to the neck region increased the risk of the other neck SNs by 4.2 % (OR = 1.042/Gy (95 %-CI 0.980-1.109)) and of thyroid SN by 5.1 % (OR = 1.051/Gy (95 %-CI 0.984-1.123)), and radiotherapy to the neck or spine region increased the thyroid risk by 6.6 % (OR = 1.066/Gy (95 %-CI 1.010-1.125)). Chemotherapy was not a confounder. Exposure to other body regions was not associated with increased risk.
Radiotherapy in the neck or spine region increases the risk of thyroid cancer, while neck exposure increases the risk of any other solid SN to a similar extent. Other studies showed a decreasing risk of subsequent thyroid cancer for very high doses; we cannot confirm this.
放射治疗与儿童癌症幸存者后续发生肿瘤（SN）的风险相关。研究表明儿童甲状腺尤其易感。目的是量化原发性癌症放射治疗后颈部再次发生肿瘤的风险，重点关注甲状腺癌。
我们进行了一项巢式病例对照研究：从德国儿童癌症登记数据库中选取了29例在1980 - 2002年间被诊断为颈部实体SN的个体，其中包括17例甲状腺癌患者，以及57例匹配的单一肿瘤对照。我们研究了按身体部位给予放射治疗的暴露风险，并对化疗进行了校正。
16/17（94.1%）例甲状腺SN病例、9/12（75%）例其他颈部SN病例和34/57（59.6%）例对照接受了放射治疗，中位剂量分别为27.8、25和24 Gy。颈部区域的放射治疗暴露使其他颈部SN的风险增加4.2%（OR = 1.042/Gy（95%CI 0.980 - 1.109）），使甲状腺SN的风险增加5.1%（OR = 1.051/Gy（95%CI 0.984 - 1.123）），颈部或脊柱区域的放射治疗使甲状腺风险增加6.6%（OR = 1.066/Gy（95%CI 1.010 - 1.125））。化疗不是混杂因素。其他身体部位的暴露与风险增加无关。
颈部或脊柱区域的放射治疗会增加甲状腺癌的风险，而颈部暴露会使任何其他实体SN的风险增加到类似程度。其他研究表明，非常高剂量时后续甲状腺癌的风险会降低；我们无法证实这一点。
