Increased stomach cancer risk following radiotherapy for testicular cancer

M Hauptmann, S D Fossa, M Stovall, F E van Leeuwen, T B Johannesen, P Rajaraman, E S Gilbert, S A Smith, R E Weathers, B M P Aleman, M Andersson, R E Curtis, G M Dores, J F Fraumeni, P Hall, E J Holowaty, H Joensuu, M Kaijser, R A Kleinerman, F LangmarkC F Lynch, E Pukkala, H H Storm, L Vaalavirta, A W van den Belt-Dusebout, L B Travis, L M Morton

    46 Citationer (Scopus)

    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.

    OriginalsprogEngelsk
    TidsskriftB J C
    Vol/bind112
    Udgave nummer1
    Sider (fra-til)44-51
    Antal sider8
    ISSN0007-0920
    DOI
    StatusUdgivet - 6 jan. 2015

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