Cooper J S, Pajak T F, Rubin P, Tupchong L, Brady L W, Leibel S A, Laramore G E, Marcial V A, Davis L W, Cox J D
NYU Medical Center, NY 10016.
Int J Radiat Oncol Biol Phys. 1989 Sep;17(3):449-56. doi: 10.1016/0360-3016(89)90094-1.
The development of second malignant tumors (SMTs), in patients who have had their first tumor treated successfully, represents a serious limitation of current therapeutic strategies for head and neck cancers. To improve our understanding of the current magnitude of the problem and the various factors that might influence its importance, we reviewed the Radiation Therapy Oncology Group's (RTOG) prospectively collected registry of all head and neck patients seen in participating member institutions between February 1977 and April 1980. A total of 928 patients were identified who had squamous cell carcinomas of the head and neck region, no prior or coincident history of another malignant tumor, and whose planned treatment consisted of radiation therapy only. A total of 110 second, independent, malignant tumors occurred in these patients. Overall, the estimated risk of developing a second tumor within 3 years of radiotherapy was 10%, within 5 years 15%, and within 8 years 23%. Minor differences in frequency were observed for different primary sites. These SMTs unquestionably influenced subsequent survival adversely. Analysis of the database also revealed that the extent of the primary tumor influenced the risk of a second; most occurred in patients who presented with the smallest primary tumors because of their better survival. Our data indicate that preventive medicine should have its greatest impact in those patients who are treated for an early stage primary tumor.
对于已成功治疗首例肿瘤的患者而言，第二原发性恶性肿瘤（SMT）的发生是当前头颈癌治疗策略的一个严重局限。为了加深我们对当前该问题严重程度以及可能影响其重要性的各种因素的理解，我们回顾了放射治疗肿瘤学组（RTOG）前瞻性收集的登记资料，这些资料来自于1977年2月至1980年4月期间参与研究的成员机构中所有诊治的头颈患者。总共确定了928例患者，他们患有头颈区域的鳞状细胞癌，既往没有其他恶性肿瘤病史，也没有同时发生其他恶性肿瘤，并且其计划治疗仅包括放射治疗。这些患者共发生了110例第二原发性、独立的恶性肿瘤。总体而言，放疗后3年内发生第二肿瘤的估计风险为10%，5年内为15%，8年内为23%。不同原发部位在发生率上存在细微差异。这些第二原发性恶性肿瘤无疑对后续生存产生了不利影响。对数据库的分析还显示，原发肿瘤的范围影响发生第二肿瘤的风险；大多数发生在原发肿瘤最小的患者中，因为他们的生存期更长。我们的数据表明，预防医学对那些接受早期原发性肿瘤治疗的患者影响最大。
