■放射治疗越来越多地用于盆腔恶性肿瘤的治疗。然而,放射的使用继续给受者带来继发性恶性肿瘤的风险.这项研究调查了原发性盆腔恶性肿瘤放疗后继发性恶性肿瘤发展的风险。
■对监测进行回顾性队列审查,流行病学,并进行了1975年至2016年的最终结果数据库。原发性盆腔恶性肿瘤根据接受放疗情况进行细分,和继发性恶性肿瘤被分层为盆腔或非盆腔,以研究辐射的局部效应。
■共分析了2.102.192例患者(前列腺的1.189.108,315.026带膀胱,88.809宫颈,249.535子宫,和259.714患有直肠/肛门癌)。任何继发性恶性肿瘤(包括但不限于继发性盆腔恶性肿瘤)的发病率(定义为每1000人年的病例)在放射患者中高于非放射患者(发病率比[IRR]1.04,置信区间[CI]1.03-1.05)。放射性前列腺患者的发病率明显更高(IRR1.22,CI1.21-1.24),子宫(IRR1.34),和宫颈癌(IRR1.80,CI1.72-1.88)。虽然放疗患者中任何继发性盆腔恶性肿瘤的总发病率较低(IRR0.79,CI0.78-0.81),在包括前列腺放射患者在内的相同队列中,发病率仍然更高(IRR1.42,CI1.39-1.45),子宫(IRR1.15,CI1.08-1.21),和宫颈癌(IRR1.72,CI1.59-1.86)。
■除了局部宫颈癌,当放在中位总生存期的背景下,辐射的影响可能不足以改变练习模式。盆腔恶性肿瘤的辐射会增加一些继发性恶性肿瘤的风险,更具体地说,继发性盆腔恶性肿瘤,但是继发性恶性肿瘤的绝对风险相对较低,对于大多数盆腔恶性肿瘤,放射治疗的益处值得继续使用.对于具有出色的癌症特异性生存率的恶性肿瘤(例如宫颈癌),应考虑进行辐射利用的实践改变。
■使用放射治疗盆腔恶性肿瘤会给受者带来继发性恶性肿瘤的风险。然而,绝对风险很低,辐射的好处保证了它的继续使用,实践模式的改变是不可能的。
UNASSIGNED: Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies.
UNASSIGNED: A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation.
UNASSIGNED: A total of 2 102 192 patients were analyzed (1 189 108 with prostate, 315 026 with bladder, 88 809 with cervical, 249 535 with uterine, and 259 714 with rectal/anal cancer). The incidence rate (defined as cases per 1000 person years) of any secondary malignancies (including but not limited to secondary pelvic malignancies) was higher in radiation patients than in nonradiation patients (incidence rate ratio [IRR] 1.04, confidence interval [CI] 1.03-1.05), with significantly greater rates noted in radiation patients with prostate (IRR 1.22, CI 1.21-1.24), uterine (IRR 1.34), and cervical (IRR 1.80, CI 1.72-1.88) cancer. While the overall incidence rate of any secondary pelvic malignancy was lower in radiation patients (IRR 0.79, CI 0.78-0.81), a greater incidence was still noted in the same cohorts including radiation patients with prostate (IRR 1.42, CI 1.39-1.45), uterine (IRR 1.15, CI 1.08-1.21), and cervical (IRR 1.72, CI 1.59-1.86) cancer.
UNASSIGNED: Except for localized cervical cancer, when put in the context of median overall survival, the impact of radiation likely does not carry enough weight to change practice patterns. Radiation for pelvic malignancies increases the risk for several secondary malignancies, and more specifically, secondary pelvic malignancies, but with a relatively low absolute risk of secondary malignancies, the benefits of radiation warrant continued use for most pelvic malignancies. Practice changes should be considered for radiation utilization in malignancies with excellent cancer-specific survival such as cervical cancer.
UNASSIGNED: The use of radiation for the management of pelvic malignancies induces a risk of secondary malignancies to its recipients. However, the absolute risk being low, the benefits of radiation warrant its continued use, and a change in practice patterns is unlikely.