作为剂量和技术函数的斗篷野放射治疗后乳腺癌的发病率。

The incidence of breast cancer following mantle field radiation therapy as a function of dose and technique.

作者信息

Tinger A, Wasserman T H, Klein E E, Miller E A, Roberts T, Piephoff J V, Kucik N A

机构信息

Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.

出版信息

Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):865-70. doi: 10.1016/s0360-3016(97)00026-6.

DOI:10.1016/s0360-3016(97)00026-6

PMID:9128963

Abstract

BACKGROUND

There is an increased incidence of breast cancer following mantle field radiation therapy for Hodgkin's disease (HD). We reviewed the experience at the Mallinckrodt Institute of Radiology (MIR) for radiation factors related to the development of breast cancer after mantle field radiation therapy for HD.

METHODS

The radiation therapy records of 152 women treated with mantle field irradiation for HD at MIR between 1966-1985 were reviewed for the development of breast cancer and treatment-related factors. All patients had a minimum of 5 years of follow-up. The treatment era (1966-1974 vs. 1975-1985), stage of HD, mediastinal dose, axillary dose, maximum dose from the anterior field (anterior d(max) dose), the anterior-posterior:posterior-anterior (AP:PA) ratio, age at the time of treatment, length of follow-up, and history of splenectomy were analyzed as possible contributing factors for the development of breast cancer. The observed number of breast cancers was compared to the expected number based on age-adjusted incidences from the Connecticut Tumor Registry.

RESULTS

Ten breast cancers occurred in the population. Eight involved an upper outer quadrant. In a multivariate analysis, the development of breast cancer was significantly associated with axillary dose. Patients in the early treatment era were at an increased risk for the development of breast cancer due to high anterior d(max) and breast doses from weighting the fields anteriorly on a low energy linear accelerator. The use of current radiation therapy techniques was not related to an increased risk of breast cancer with a median follow-up of 13 years.

CONCLUSIONS

A high dose to the axilla and the anterior d(max) point is significantly associated with the development of breast cancer after mantle field irradiation for HD. Efforts to protect the breast from high doses will likely lessen the increased risk of breast cancer in women treated with radiation therapy for HD.

摘要

背景

霍奇金淋巴瘤（HD）患者接受斗篷野放射治疗后，乳腺癌发病率有所增加。我们回顾了马林克罗德特放射研究所（MIR）在HD患者接受斗篷野放射治疗后与乳腺癌发生相关的放射因素的经验。

方法

回顾了1966年至1985年间在MIR接受斗篷野照射治疗HD的152名女性的放射治疗记录，以了解乳腺癌的发生情况及与治疗相关的因素。所有患者至少随访5年。分析治疗时代（1966 - 1974年与1975 - 1985年）、HD分期、纵隔剂量、腋窝剂量、前野最大剂量（前d(max)剂量）、前后比（AP:PA）、治疗时年龄、随访时间以及脾切除术史等可能是乳腺癌发生的影响因素。将观察到的乳腺癌病例数与基于康涅狄格肿瘤登记处年龄调整发病率的预期病例数进行比较。