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. 2015 Jan 6;112(1):44-51.
doi: 10.1038/bjc.2014.552. Epub 2014 Nov 4.

Increased stomach cancer risk following radiotherapy for testicular cancer

M Hauptmann  1 , S D Fossa  2 , M Stovall  3 , F E van Leeuwen  1 , T B Johannesen  4 , P Rajaraman  5 , E S Gilbert  5 , S A Smith  3 , R E Weathers  3 , B M P Aleman  6 , M Andersson  7 , R E Curtis  5 , G M Dores  8 , J F Fraumeni  5 , P Hall  9 , E J Holowaty  10 , H Joensuu  11 , M Kaijser  12 , R A Kleinerman  5 , F Langmark  4 , C F Lynch  13 , E Pukkala  14 , H H Storm  15 , L Vaalavirta  11 , A W van den Belt-Dusebout  1 , L B Travis  16 , L M Morton  5
Affiliations

Increased stomach cancer risk following radiotherapy for testicular cancer

M Hauptmann et al. Br J Cancer. .

Abstract

Background: Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse.

Methods: In a cohort of 22,269 5-year TC survivors diagnosed during 1959-1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression.

Results: Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7-20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7-114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5-2.5; 14 cases and 23 controls).

Conclusions: Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.

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Figures

Figure 1
Figure 1
Mean radiation dose of cases and controls to the stomach, by stomach region, for specific testicular cancer radiotherapy fields.Note that percentages add to >100 as most patients were treated using more than one field type (parallel and opposing fields are combined for this purpose). *Includes inverted Y and spade. †Other known fields include those to the mediastinum, neck or supraclavicular area, testes, spine, chest other than para-aortic and head.
Figure 2
Figure 2
Radiation dose–response relationship for stomach cancer following testicular cancer based on 92 cases and 180 controls.Filled circles and error bars indicate odds ratios and 95% confidence intervals for categories of dose to the stomach tumour location in cases and a corresponding location in controls (as shown in Table 2) plotted at the mean dose per category. The solid line indicates the linear EOR per Gy (0.27, 95% CI 0.054–1.44) forced to pass through unity (dashed line) at the mean of the reference category (2.5 Gy). The ordinate is broken at the horizontal zigzag lines in order to display the upper confidence bound of the highest dose category.
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References

    1. Arvold ND, Catalano PJ, Sweeney CJ, Hoffman KE, Nguyen PL, Balboni TA, Fosså SD, Travis LB, Beard CJ. Barriers to the implementation of surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2012;84 (2:383–389. - PubMed
    1. Berrington de Gonzalez A, Gilbert E, Curtis R, Inskip P, Kleinerman R, Morton L, Rajaraman P, Little MP. Second solid cancers after radiation therapy: A systematic review of the epidemiologic studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013;86 (2:224–233. - PMC - PubMed
    1. Biggs ML, Schwartz SM.2007Cancer of the testisIn: Ries LA, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ, (eds)SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics National Cancer Institute; SEER Program, NIH Pub. No. 07-6215Bethesda, MD; 175–180.
    1. Birdwell SH, Hancock SL, Varghese A, Cox RS, Hoppe RT. Gastrointestinal cancer after treatment of Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1997;37:67–73. - PubMed
    1. Brenner H, Rothenbacher D, Arndt V. Epidemiology of stomach cancer. Methods Mol Biol. 2009;472:467–477. - PubMed

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