可切除乳腺癌中基于CMF的辅助化疗后的第二原发性恶性肿瘤。

Second malignancies following CMF-based adjuvant chemotherapy in resectable breast cancer.

作者信息

Valagussa P, Moliterni A, Terenziani M, Zambetti M, Bonadonna G

机构信息

Division of Medical Oncology, Istituto Nazionale Tumori, Milan, Italy.

出版信息

Ann Oncol. 1994 Nov;5(9):803-8. doi: 10.1093/oxfordjournals.annonc.a059008.

DOI:10.1093/oxfordjournals.annonc.a059008

PMID:7848882

Abstract

BACKGROUND

Only a few studies have evaluated the long-term effects of adjuvant chemotherapy for breast cancer. Furthermore, neither the relation between the risk of second malignancies and type of adjuvant regimen utilized nor the interaction between chemotherapy and breast irradiation or age of the patients have been described in detail.

METHODS

A total of 2,465 patients entered into prospective studies of CMF-based adjuvant chemotherapy carried out at the Milan Cancer Institute between June 1973 and July 1990 were evaluated. The median follow-up was 12.0 years and detailed information about therapy was available for all patients.

RESULTS

At 15 years, the cumulative actuarial risk of second malignancies (excluding contralateral breast cancer and basal skin cancer) was 6.7% +/- 0.8% for the total series. The figures were 8.4% +/- 2.9% after local-regional treatment alone, 6.4% +/- 0.9% following CMF, and 5.1% +/- 1.0% following CMF plus Adriamycin (doxorubicin; Farmitalia-Carlo Erba, Milan, Italy). Compared to the general female population, the relative risk following CMF-based adjuvant chemotherapy was 1.29. Three patients, all of whom had received CMF-based chemotherapy, developed acute non-lymphocytic leukemia (cumulative risk 0.23% +/- 0.15%; relative risk 2.3). No differences were evident when breast irradiation was considered, but the cumulative risk of second tumors was slightly higher in women aged > or = 50 years at surgery (7.7% +/- 1.3%) than in younger patients (6.0% +/- 1.0%).

CONCLUSIONS

At present, there is no evidence of a significantly increased risk of second malignancies following adjuvant CMF-based chemotherapy such as the one given in this case series. A low risk of acute leukemia was associated with the cumulative total dose of cyclophosphamide administered, and breast irradiation did not enhance this risk.

IMPLICATIONS

Our findings suggest that there is no reason to omit alkylating agents from short-term effective adjuvant chemotherapy.

摘要

背景

仅有少数研究评估了乳腺癌辅助化疗的长期效果。此外，关于第二原发恶性肿瘤风险与所用辅助治疗方案类型之间的关系，以及化疗与乳腺放疗或患者年龄之间的相互作用，均未得到详细描述。

方法

对1973年6月至1990年7月在米兰癌症研究所进行的基于CMF的辅助化疗前瞻性研究中纳入的2465例患者进行了评估。中位随访时间为12.0年，所有患者均有详细的治疗信息。

结果

15年时，整个队列中第二原发恶性肿瘤（不包括对侧乳腺癌和基底皮肤癌）的累积精算风险为6.7%±0.8%。单纯局部区域治疗后的风险为8.4%±2.9%，CMF方案治疗后为6.4%±0.9%，CMF加阿霉素（多柔比星；意大利米兰法玛西亚-卡洛埃巴公司）方案治疗后为5.1%±1.0%。与一般女性人群相比，基于CMF的辅助化疗后的相对风险为1.29。3例患者均接受了基于CMF的化疗，发生了急性非淋巴细胞白血病（累积风险0.23%±0.15%；相对风险2.3）。考虑乳腺放疗时无明显差异，但手术时年龄≥50岁的女性第二肿瘤累积风险（7.7%±1.3%）略高于年轻患者（6.0%±1.0%）。