霍奇金病年轻女性患者接受放疗后患乳腺癌的风险很高。

High risk of breast carcinoma after irradiation of young women with Hodgkin's disease.

作者信息

Aisenberg A C, Finkelstein D M, Doppke K P, Koerner F C, Boivin J F, Willett C G

机构信息

Department of Medicine, Massachusetts General Hospital, Boston 02114, USA.

出版信息

Cancer. 1997 Mar 15;79(6):1203-10. doi: 10.1002/(sici)1097-0142(19970315)79:6<1203::aid-cncr20>3.0.co;2-2.

DOI:10.1002/(sici)1097-0142(19970315)79:6<1203::aid-cncr20>3.0.co;2-2

PMID:9070499

Abstract

BACKGROUND

Treatment-associated second neoplasms have emerged as a major threat to the continued survival of patients cured of Hodgkin's disease. In this study, the authors investigated the risk of breast carcinoma in an irradiated Hodgkin's disease population.

METHODS

One hundred and eleven women younger than 60 years presenting between 1964 and 1984 with Stage I and II Hodgkin's disease who received mantle irradiation were retrospectively analyzed and compared with an age specific population. Median follow-up was 18 years (range, 10-30 years), and the median age at initiation of therapy was 24 years. Kaplan-Meier actuarial risks, relative risks (RRs) (the ratio of the observed to the expected cases) with 95% confidence intervals (CIs), and the log rank test for trends were calculated.

RESULTS

Fourteen women developed breast carcinoma: 8 of 33 patients younger than 20 years at the time of irradiation, 5 of 48 patients age 20 to 29 years, and 1 of 30 patients age 30 years or older. Actuarial calculation predicted a 34.0% (CI, 14.2-53.8) risk of breast carcinoma at 25 years after therapy for the youngest group, 22.3% (CI, 4.1-40.5) for the group of intermediate age, and 3.5% (CI, 0-10.1) for the oldest group. The RR of breast carcinoma was 56 (CI, 23.3-107) for those 19 years or younger at the time of treatment, 7.0 (CI, 2.3-16.4) for those age 20-29 years, and 0.9 (CI, 0-5.3) for those 30 years and older. Excluding 1 patient who was age 38 years at the time of irradiation, the remaining 13 breast carcinomas were tightly clustered in women irradiated between the ages of 14 through 25, and were detected in years 11 through 25 after treatment, with 7 occurring in years 15 through 18.

CONCLUSIONS

Women younger than 30 years, particularly those younger than 20 years, who have received mantle irradiation for Hodgkin's disease require meticulous follow-up for breast carcinoma. The high incidence of breast carcinoma in this patient population should be considered when making treatment decisions in young women with early stage Hodgkin's disease.

摘要

背景

与治疗相关的第二原发性肿瘤已成为治愈霍奇金病患者持续生存的主要威胁。在本研究中，作者调查了接受放疗的霍奇金病患者人群中患乳腺癌的风险。

方法

回顾性分析了1964年至1984年间年龄小于60岁、患有Ⅰ期和Ⅱ期霍奇金病且接受斗篷野放疗的111名女性，并与特定年龄人群进行比较。中位随访时间为18年（范围10 - 30年），治疗开始时的中位年龄为24岁。计算了Kaplan - Meier精算风险、相对风险（RRs）（观察病例与预期病例之比）及其95%置信区间（CIs），以及趋势的对数秩检验。

结果

14名女性患乳腺癌：放疗时年龄小于20岁的33名患者中有8例，年龄在20至29岁的48名患者中有5例，年龄30岁及以上的30名患者中有1例。精算计算预测，最年轻组在治疗后25年患乳腺癌的风险为34.0%（CI，14.2 - 53.8），中年组为22.3%（CI，4.1 - 40.5），最年长组为3.5%（CI，0 - 10.1）。治疗时年龄在19岁或以下的患者患乳腺癌的RR为56（CI，23.3 - 107），年龄在20 - 29岁的患者为7.0（CI，2.3 - 16.4），年龄30岁及以上的患者为0.9（CI，0 - 5.3）。排除1例放疗时年龄为38岁的患者后，其余13例乳腺癌紧密聚集在年龄在14至25岁之间接受放疗的女性中，且在治疗后11至25年被检测到，其中7例发生在15至18年。