Boice J D, Hutchison G B
J Natl Cancer Inst. 1980 Jul;65(1):115-29.
An international collaborative study of 31,219 women treated for cervical cancer from 30 radiotherapy centers in nine countries was conducted. Patients were followed clinically and with blood studies between 1960 and 1970, and 148,000 woman-years (WY) were accumulated. Among 28,490 women treated with either intercavitary radium, external radiation, or both, 134,000 WY were accumulated and 13 cases of leukemia were observed. On the basis of general population rates, 15.5 cases were expected [relative risk (RR) = 0.8; 95% confidence limits (CL) = 0.4-1.4]. A twofold risk could thus be excluded, but a 1.4-fold risk remained possible. In absolute terms, risks larger than 0.1 leukemia cases per 10(6) WY-rad could be excluded. Among 2,729 cervical cancer patients not irradiated but similarly evaluated, 14,000 WY were accumulated and 2 cases of leukemia were observed as compared with 1.0 expected. In the interval 4-8 years after exposure, the period in which any leukemogenic effect might be most apparent, 7 cases of leukemia were observed among exposed patients as compared with 5.4 expected (RR - 1.3; 95% CL = 0.5-2.7). The absence of an increased leukemia risk suggested that the radiation regimens used to treat cervical cancer are not so effective in inducing leukemia as are other radiation exposures that have been studied.
一项针对来自九个国家30个放疗中心的31219名接受宫颈癌治疗的女性的国际合作研究展开。在1960年至1970年间对患者进行了临床随访和血液研究，累计随访了148000人年（WY）。在28490名接受腔内镭疗、外照射或两者联合治疗的女性中，累计随访了134000人年，观察到13例白血病病例。根据一般人群发病率，预计有15.5例[相对风险（RR）=0.8；95%置信区间（CL）=0.4 - 1.4]。因此可以排除两倍的风险，但1.4倍的风险仍有可能。从绝对数值来看，可以排除每10^6人年 - 拉德大于0.1例白血病的风险。在2729名未接受放疗但经过类似评估的宫颈癌患者中，累计随访了14000人年，观察到2例白血病病例，而预期为1.0例。在暴露后的4至8年期间，这可能是任何白血病致病效应最明显的时期，在暴露患者中观察到7例白血病病例，而预期为5.4例（RR = 1.3；95% CL = 0.5 - 2.7）。白血病风险未增加表明，用于治疗宫颈癌的放疗方案在诱发白血病方面不如其他已研究的辐射暴露有效。
