Department of Clinical Research, Gustave Roussy, Villejuif, France2Radiation Epidemiology Team, Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Medicale Unit 1018, Villejuif, France3Department of.
Department of Clinical Research, Gustave Roussy, Villejuif, France.
JAMA Ophthalmol. 2016 Apr;134(4):390-7. doi: 10.1001/jamaophthalmol.2015.6088.
Few studies have been published on the association of the radiation dose received to the eyes during radiotherapy (RT) for childhood cancer and the risk for later cataract.
To investigate the risk for cataract after treatment of nonretinoblastoma solid cancer in childhood.
DESIGN, SETTING, AND PARTICIPANTS: The study used data from the Euro2K cohort that includes 4389 5-year survivors of solid tumors treated from January 1, 1945, to December 31, 1985; of these, 3172 patients were treated in France. A self-reported questionnaire was sent to French survivors from September 1, 2005, to December 31, 2012, when follow-up was considered completed for this study. However, 619 patients died before the beginning of the study and 128 patients treated for a retinoblastoma or who underwent enucleation were excluded. Likewise, 429 patients with unknown addresses or who did not return the consent form and 163 nonresponders did not participate. The remaining 1833 patients who completed the questionnaire underwent analysis for this study from June 1, 2014, to December 7, 2015.
Radiation doses in both eyes for individuals were estimated for all patients who had received RT. The role of the radiation dose in cataract risk was investigated using the Cox proportional hazard regression model and the excess relative or the absolute risk model. The role of ctytotoxic chemotherapy was also investigated.
The 1833 patients (961 men [52.4%]; 872 women [47.6%]; mean [SD] age, 37.0 [8.5]) who returned the questionnaire were included in the analysis. After a mean follow-up of 32 years, 33 patients with unilateral or bilateral cataract were identified, for a total of 47 cataract events. The 47 events were validated by medical record review and by contacting the patients and the corresponding medical physician or ophthalmologist to obtain copies of diagnostic examinations or surgical reports. Overall, in a multivariable Cox proportional hazard regression analysis, patients who received RT had a 4.4-fold (95% CI, 1.5- to 13.0-fold) increased risk for cataract compared with patients who did not receive RT. Exposure to radiation doses of at least 10 Gy to the eyes increased the hazard ratio 39-fold (95% CI, 12.0- to 127.9-fold), relative to no radiation exposure. Although based on few patients, a strong increase in cataract risk (hazard ratio, 26.3; 95% CI, 7.1-96.6) was observed in patients treated with melphalan hydrochloride.
This study can inform guideline-based recommendations for long-term follow-up for cataract.
鲜有研究发表过关于儿童癌症放射治疗（RT）期间眼部接受的辐射剂量与日后白内障风险之间的关联。
研究儿童期非视网膜母细胞瘤实体瘤治疗后的白内障发病风险。
设计、地点和参与者：该研究使用了欧洲 2K 队列的数据，该队列包括 4389 名于 1945 年 1 月 1 日至 1985 年 12 月 31 日期间接受治疗的实体瘤 5 年幸存者；其中，3172 名患者在法国接受治疗。2005 年 9 月 1 日至 2012 年 12 月 31 日期间，向法国幸存者发送了一份自我报告调查问卷，此时该研究的随访工作被认为已完成。然而，有 619 名患者在研究开始前死亡，128 名患者因患有视网膜母细胞瘤或接受眼球摘除术而被排除在外。同样，有 429 名患者因地址不详或未返回同意书，以及 163 名未回复者而未参与。其余 1833 名完成调查问卷的患者于 2014 年 6 月 1 日至 2015 年 12 月 7 日接受了分析。
所有接受过 RT 的患者，其双眼的辐射剂量均被估计。使用 Cox 比例风险回归模型和超额相对或绝对风险模型来研究辐射剂量在白内障风险中的作用。细胞毒性化疗的作用也进行了研究。
在收到问卷的 1833 名患者（男性 961 名[52.4%]；女性 872 名[47.6%]；平均[标准差]年龄 37.0[8.5]）中，有 33 名患者单侧或双侧白内障，总计 47 例白内障事件。通过病历回顾、联系患者和相应的医生或眼科医生以获取诊断检查或手术报告的复印件，对 47 例白内障事件进行了验证。总体而言，在多变量 Cox 比例风险回归分析中，与未接受 RT 的患者相比，接受 RT 的患者白内障发病风险增加了 4.4 倍（95%CI，1.5 至 13.0 倍）。与未接受辐射暴露的患者相比，眼睛接受至少 10 Gy 的辐射剂量，会使风险比增加 39 倍（95%CI，12.0 至 127.9 倍）。尽管基于少数患者，但是接受盐酸马法兰治疗的患者的白内障发病风险显著增加（风险比，26.3；95%CI，7.1 至 96.6）。
本研究可为基于指南的白内障长期随访建议提供信息。
