• British journal of cancer · Jan 2015

    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, AlemanB M PBM1] Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands [2] Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., 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, and L M Morton.
    • Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
    • Br. J. Cancer. 2015 Jan 6; 112 (1): 44-51.

    BackgroundAbdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse.MethodsIn 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.ResultsCumulative 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).ConclusionsRadiotherapy 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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