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Comparative Study
. 2018 Oct;119(7):901-907.
doi: 10.1038/s41416-018-0248-x. Epub 2018 Oct 9.

Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J Groot  1 , Jourik A Gietema  2 , Berthe M P Aleman  3 , Luca Incrocci  4 , Ronald de Wit  5 , J Alfred Witjes  6 , Gerard Groenewegen  7 , Peter de Brouwer  8 , Otto W M Meijer  9 , Maarten C C M Hulshof  10 , Hetty A van den Berg  11 , Tineke J Smilde  12 , Ben G L Vanneste  13 , Maureen J Aarts  14 , Alphonsus C M van den Bergh  15 , J Martijn Kerst  16 , Alexandra W van den Belt-Dusebout  1 , Sjoukje Lubberts  2 , Katarzina Jóźwiak  17 , Simon Horenblas  18 , Flora E van Leeuwen  1 , Michael Schaapveld  19
Affiliations
Comparative Study

Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J Groot et al. Br J Cancer. 2018 Oct.

Abstract

Background: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.

Methods: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.

Results: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI: -0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.

Conclusion: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Incidence of diabetes among testicular cancer survivors treated with para-aortic radiotherapy compared to orchidectomy only. PAO para-aortic irradiation. Diabetes incidence was significantly increased after para-aortic radiotherapy (P < 0.001)
Fig. 2
Fig. 2
Risk of diabetes by prescribed para-aortic radiation dose among testicular cancer survivors. HRs for diabetes risk for prescribed dose categories are plotted at the mean dose within each category (26 Gy for ≤26GY, 30 Gy for 27–32 Gy and 40 Gy for ≥33 Gy). Vertical lines represent the 95% CI for each category of dose. The HRs for determining the excess risk increase per 10 Gray (ERR) were derived from a model with adjustment for age and BMI continuously. The excess risk was estimated based on the following dose categories: 10–24 Gy, 25 Gy, 26 Gy, 27–30 Gy, 31–39 Gy and ≥40 Gy, with median doses of 21, 25, 26, 30, 33, 40 and 50 Gy
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References

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