- 作者：Aurore Allard ; Nadia Haddy ; Marie-Cé ; cile Le Deley ; Carole Rubino ; Mathilde Lassalle ; Akthar Samsaldin ; Eric Quiniou ; Agnè ; s Chompret ; Dimitri Lefkopoulos ; Ibrahima Diallo ; Florent de Vathaire
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2010
- 出版时间：1 December 2010
- 年：2010
- 卷：78
- 期：5
- 页码：1474-1482
- 全文大小：253 K
Purpose
The purpose of this study was to estimate the risk of secondary leukemia as a function of radiation dose, taking into account heterogeneous radiation dose distribution.Methods and Materials
We analyzed a case–control study that investigated the risk of secondary leukemia and myelodysplasia after a solid tumor in childhood; it included 61 patients with leukemia matched with 196 controls. Complete clinical, chemotherapy, and radiotherapy histories were recorded for each patient in the study. Average radiation dose to each of seven bone marrow components for each patient was incorporated into the models, and corresponding risks were summed up. Conditional maximum likelihood methods were used to estimate risk parameters.
Results
Whatever the model, we failed to evidence a role for the radiation dose to active bone marrow in the risk of later leukemia, myelodysplasia, or myeloproliferative syndrome, when adjusting for epipodophyllotoxin and anthracycline doses. This result was confirmed when fitting models that included total dose of radiation delivered during radiotherapy, when fitting models taking into account dose per fraction, and when restricting the analysis to acute myeloid leukemia.
Conclusions
In contrast to results found in similar studies that included children treated before the use of epipodophyllotoxins, this study failed to show a role for radiotherapy in the risk of secondary leukemia after childhood cancer in children treated between 1980 and 1999. This discrepancy was probably due to a competitive mechanism between these two carcinogens.