Griem M L, Kleinerman R A, Boice J D, Stovall M, Shefner D, Lubin J H
Department of Radiation Oncology, University of Chicago, Ill 60637.
J Natl Cancer Inst. 1994 Jun 1;86(11):842-9. doi: 10.1093/jnci/86.11.842.
Radiotherapy for peptic ulcer was used between 1937 and 1965 to control excessive gastric acid secretions (mean dose, 14.8 Gy). Patients with this benign condition live many years after treatment and are at risk for late effects.
Our purpose was to investigate the risk of death from cancer following radiotherapy for peptic ulcer.
A mortality study was conducted of 3609 patients with peptic ulcer; 1831 were treated with radiation and 1778 were treated by other means. Extensive methods were used to trace patients. Radiation doses to specific organs were reconstructed from the original radiotherapy records.
Nearly 70% of patients were found to have died. The average period of observation was 21.5 years (maximum 51 years). Compared with the general population, patients treated with or without radiation were at significantly increased risk of dying of cancer and non-malignant diseases of the digestive system. Risk of death due to heart disease was slightly higher following radiotherapy. Cancers of the stomach, pancreas, lung, and prostate were increased in both irradiated and nonirradiated patients. Radiotherapy was linked to significantly high relative risks (RRs) for all cancers combined (RR = 1.53; 95% confidence interval [CI] = 1.3-1.8), for cancers of the stomach (RR = 2.77; 95% CI = 1.6-4.8), pancreas (RR = 1.87; 95% CI = 1.0-3.4), and lung (RR = 1.70; 95% CI = 1.2-2.4), and for leukemia (RR = 3.28; 95% CI = 1.0-10.6). Radiation combined with surgery, or given to treat gastric ulcer, appeared to increase the risk of stomach cancer 10-fold, which was greater than the sum of individual effects. Patients with gastric ulcers were at higher risk for stomach cancer than patients with duodenal ulcers.
Patients with peptic ulcer are at increased risk of dying of cancer, related in part to lifestyle factors and treatment. Radiotherapy and surgery together appear to induce carcinogenic processes that greatly enhance the development of stomach cancer. The risk of radiation-induced stomach cancer was 0.25 extra deaths per 10,000 persons per year per Gy, somewhat lower than reported in other studies. High-dose radiation may have increased the risk of pancreatic cancer, a condition rarely found elevated in irradiated populations, but misclassified death notices may have contributed to the excess. Cancer mortality remained high for up to 50 years, indicating that radiation damage may persist to the end of life.
1937年至1965年间，曾采用放射疗法治疗消化性溃疡以控制胃酸过度分泌（平均剂量为14.8 Gy）。患有这种良性疾病的患者在接受治疗后可存活多年，存在发生晚期效应的风险。
我们的目的是调查消化性溃疡放射治疗后死于癌症的风险。
对3609例消化性溃疡患者进行了一项死亡率研究；其中1831例接受了放射治疗，1778例采用了其他治疗方法。采用广泛的方法追踪患者。根据原始放射治疗记录重建特定器官的辐射剂量。
发现近70%的患者已经死亡。平均观察期为21.5年（最长51年）。与普通人群相比，接受或未接受放射治疗的患者死于癌症和消化系统非恶性疾病的风险显著增加。放射治疗后死于心脏病的风险略高。接受照射和未接受照射的患者中，胃癌、胰腺癌、肺癌和前列腺癌的发病率均有所增加。放射治疗与所有癌症合并的显著高相对风险（RR = 1.53；95%置信区间[CI] = 1.3 - 1.8）、胃癌（RR = 2.77；95% CI = 1.6 - 4.8）、胰腺癌（RR = 1.87；95% CI = 1.0 - 3.4）、肺癌（RR = 1.70；95% CI = 1.2 - 2.4）以及白血病（RR = 3.28；95% CI = 1.0 - 10.6）相关。放射治疗与手术联合使用，或用于治疗胃溃疡，似乎使胃癌风险增加了10倍，这大于个体效应的总和。胃溃疡患者患胃癌的风险高于十二指肠溃疡患者。
消化性溃疡患者死于癌症的风险增加，部分与生活方式因素和治疗有关。放射治疗和手术一起似乎会诱发致癌过程，大大增加胃癌的发生。放射诱发胃癌的风险为每10000人每年每Gy额外增加0.25例死亡，略低于其他研究报告的结果。高剂量辐射可能增加了胰腺癌的风险，这种情况在接受照射的人群中很少发现升高，但死亡通知的错误分类可能导致了这种超额情况。癌症死亡率在长达50年内一直居高不下，表明辐射损伤可能会持续到生命结束。
