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 Langmark; C F Lynch; E Pukkala; H H Storm; L Vaalavirta; A W van den Belt-Dusebout; L B Travis; L M Morton

doi:10.1038/bjc.2014.552

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

51 Citations (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.

Original language	English
Journal	B J C
Volume	112
Issue number	1
Pages (from-to)	44-51
Number of pages	8
ISSN	0007-0920
DOIs	https://doi.org/10.1038/bjc.2014.552
Publication status	Published - 6 Jan 2015

Keywords

Adolescent
Adult
Aged
Case-Control Studies
Cohort Studies
Dose-Response Relationship, Radiation
Female
Humans
Incidence
Male
Middle Aged
Neoplasms, Radiation-Induced
Radiotherapy Dosage
Stomach Neoplasms
Survivors
Testicular Neoplasms
Young Adult

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Hauptmann, M., Fossa, S. D., Stovall, M., van Leeuwen, F. E., Johannesen, T. B., Rajaraman, P., Gilbert, E. S., Smith, S. A., Weathers, R. E., Aleman, B. M. P., Andersson, M., Curtis, R. E., Dores, G. M., Fraumeni, J. F., Hall, P., Holowaty, E. J., Joensuu, H., Kaijser, M., Kleinerman, R. A., ... Morton, L. M. (2015). Increased stomach cancer risk following radiotherapy for testicular cancer. B J C, 112(1), 44-51. https://doi.org/10.1038/bjc.2014.552

Hauptmann, M, Fossa, SD, Stovall, M, van Leeuwen, FE, Johannesen, TB, Rajaraman, P, Gilbert, ES, Smith, SA, Weathers, RE, Aleman, BMP, Andersson, M, Curtis, RE, Dores, GM, Fraumeni, JF, Hall, P, Holowaty, EJ, Joensuu, H, Kaijser, M, Kleinerman, RA, Langmark, F, Lynch, CF, Pukkala, E, Storm, HH, Vaalavirta, L, van den Belt-Dusebout, AW, Travis, LB & Morton, LM 2015, 'Increased stomach cancer risk following radiotherapy for testicular cancer', B J C, vol. 112, no. 1, pp. 44-51. https://doi.org/10.1038/bjc.2014.552

@article{fe29b181012c427fbc66506595fea338,

title = "Increased stomach cancer risk following radiotherapy for testicular 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.",

keywords = "Adolescent, Adult, Aged, Case-Control Studies, Cohort Studies, Dose-Response Relationship, Radiation, Female, Humans, Incidence, Male, Middle Aged, Neoplasms, Radiation-Induced, Radiotherapy Dosage, Stomach Neoplasms, Survivors, Testicular Neoplasms, Young Adult",

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

year = "2015",

month = jan,

day = "6",

doi = "10.1038/bjc.2014.552",

language = "English",

volume = "112",

pages = "44--51",

journal = "B J C",

issn = "0007-0920",

publisher = "Nature Publishing Group",

number = "1",

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TY - JOUR

T1 - Increased stomach cancer risk following radiotherapy for testicular cancer

AU - Hauptmann, M

AU - Fossa, S D

AU - Stovall, M

AU - van Leeuwen, F E

AU - Johannesen, T B

AU - Rajaraman, P

AU - Gilbert, E S

AU - Smith, S A

AU - Weathers, R E

AU - Aleman, B M P

AU - Andersson, M

AU - Curtis, R E

AU - Dores, G M

AU - Fraumeni, J F

AU - Hall, P

AU - Holowaty, E J

AU - Joensuu, H

AU - Kaijser, M

AU - Kleinerman, R A

AU - Langmark, F

AU - Lynch, C F

AU - Pukkala, E

AU - Storm, H H

AU - Vaalavirta, L

AU - van den Belt-Dusebout, A W

AU - Travis, L B

AU - Morton, L M

PY - 2015/1/6

Y1 - 2015/1/6

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Case-Control Studies

KW - Cohort Studies

KW - Dose-Response Relationship, Radiation

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Neoplasms, Radiation-Induced

KW - Radiotherapy Dosage

KW - Stomach Neoplasms

KW - Survivors

KW - Testicular Neoplasms

KW - Young Adult

UR - https://www.scopus.com/pages/publications/84920680761

U2 - 10.1038/bjc.2014.552

DO - 10.1038/bjc.2014.552

M3 - Journal article

C2 - 25349972

SN - 0007-0920

VL - 112

SP - 44

EP - 51

JO - B J C

JF - B J C

IS - 1

ER -

Increased stomach cancer risk following radiotherapy for testicular cancer

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