Radiotherapy for Testicular Cancer Increases Risk of Stomach Cancer

By Sharon Nirenberg MD

December 05, 2014

NEW YORK (Reuters Health) - Abdominal radiotherapy for testicular cancer raises a patient's risk of developing stomach cancer for several decades, according to a recent study.

The findings, published online November 4 in the British Journal of Cancer, show that the risk was highest for testicular cancer patients who received abdominal radiotherapy at doses of 30 Gy or greater.

"Our findings add to the knowledge of potential adverse sequelae associated with radiotherapy in testicular cancer survivors," lead author of the study, Dr. Michael Hauptmann, a biostatistician at The Netherlands Cancer Institute in Amsterdam, told Reuters Health by email.

"When radiation therapy (including a boost to the upper abdomen) is considered in testicular cancer treatment plans with curative intent, clinicians and patients should be aware of radiation-related stomach cancer risk that persists for more than 20 years, and carefully consider the short- and long-term risks and benefits of therapy in their decision making," he said.

Dr. Hauptmann and colleagues conducted a nested case-control study within a cohort of more than 22,000 patients from the United States, Denmark, Finland, Canada, Sweden and Norway who were five-year survivors of testicular cancer.

Of the total cohort, 92 survivors subsequently developed stomach cancer and were compared to 180 matched controls from the cohort who did not develop stomach cancer.

Thirty years after initial diagnosis with testicular cancer, the cumulative incidence of stomach cancer was 1.45% within the cohort. A 5.9-fold increased risk of stomach cancer was found for testicular cancer patients who received radiation treatment (95% stomach cancer cases, 84% controls).

A higher dose of radiation to the stomach was associated with a significantly higher risk of stomach cancer (odds ratio, 20.5 for >=50.0 Gy compared with <10 Gy). And the extra risk remained significant more than 20 years after treatment (p<0.001).

"Clinicians should be aware of this risk when previously irradiated testicular cancer survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed testicular cancer patients," said Dr. Lois B. Travis, a co-author of the study and Director of the Rubin Center for Cancer Survivorship at University of Rochester Medical Center in Rochester, New York.

"Although the proportion of testicular cancer patients receiving radiotherapy has decreased substantially during recent decades, presently up to one-third of seminoma patients may receive radiotherapy, although with smaller fields and lower doses than are used in this study," Dr. Travis told Reuters Health by email.


Br J Cancer 2014.


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