Gan Meng, Boothe Dustin, Neklason Deborah W, Samadder N Jewel, Frandsen Jonathan, Keener Megan B, Lloyd Shane
University of Utah School of Medicine; Salt Lake City, UT, USA.
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah; Salt Lake City, UT, USA.
J Gastrointest Oncol. 2017 Aug;8(4):643-649. doi: 10.21037/jgo.2017.03.01.
The outcomes, complications, and rates of secondary malignancies from radiation therapy (RT) are not known for patients with familial adenomatous polyposis (FAP).
We queried the Hereditary Gastrointestinal Cancer Registry (HGCR) for patients with FAP who received RT. Outcomes assessed included acute and late treatment toxicity and secondary malignancies.
We identified 15 patients undergoing 18 treatment courses. Median follow-up was 3.1 years after RT. Treated sites included rectal cancer, desmoid, prostate cancer, breast cancer, melanoma, medulloblastoma, gastric cancer, and glioma. Secondary tumors occurred in two patients: a medulloblastoma was diagnosed in a patient treated for glioma, and a desmoid tumor was diagnosed in a patient treated for rectal cancer. All nine patients treated with intra-abdominal or pelvic RT had prior prophylactic proctocolectomies, yet only one patient experienced grade 3 gastrointestinal toxicity. Common Terminology Criteria for Adverse Events version 4 (CTCAE v4) toxicities were grade 1 in seven treatment courses (39%), grade 2 in five courses (28%), and grade 3 in two courses (11%).
In this cohort, RT was well tolerated with adverse effects comparable with non-FAP patients. Secondary in-field tumors occurred in 2 of 15 patients and their increased risk in this cohort was likely due to prior predilection from FAP itself, although an increased role of RT cannot be ruled out.
家族性腺瘤性息肉病（FAP）患者接受放射治疗（RT）后的结局、并发症及继发性恶性肿瘤发生率尚不清楚。
我们查询了遗传性胃肠道癌症登记处（HGCR）中接受RT的FAP患者。评估的结局包括急性和晚期治疗毒性以及继发性恶性肿瘤。
我们确定了15例接受18个疗程治疗的患者。RT后中位随访时间为3.1年。治疗部位包括直肠癌、硬纤维瘤、前列腺癌、乳腺癌、黑色素瘤、髓母细胞瘤、胃癌和神经胶质瘤。两名患者发生了继发性肿瘤：一名接受神经胶质瘤治疗的患者被诊断出髓母细胞瘤，一名接受直肠癌治疗的患者被诊断出硬纤维瘤。所有9例接受腹内或盆腔RT治疗的患者均曾接受预防性直肠结肠切除术，但只有1例患者出现3级胃肠道毒性。不良事件通用术语标准第4版（CTCAE v4）毒性在7个疗程（39%）中为1级，在5个疗程（28%）中为2级，在2个疗程（11%）中为3级。
在该队列中，RT耐受性良好，不良反应与非FAP患者相当。15例患者中有2例发生了继发性野内肿瘤，该队列中其风险增加可能是由于FAP本身先前的易感性，尽管不能排除RT作用增加的可能性。
