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Radiotherapy for testicular cancer increased risk for subsequent stomach cancer
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Survivors of testicular cancer who underwent abdominal radiotherapy demonstrated long-term elevated risk for subsequent stomach cancers, according to results of an international case–control study.
Participants who received doses of at least 30 Gy demonstrated the greatest risk, results showed.
Michael Hauptmann
“Our findings add to the knowledge of potential adverse sequelae associated with radiotherapy in testicular cancer survivors” Michael Hauptmann, PhD, senior statistician and head of the biostatistics group in the department of epidemiology and biostatistics at Netherlands Cancer Institute in Amsterdam, told HemOnc Today. “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.”
The analysis included 22,269 individuals from seven countries diagnosed with testicular cancer between 1959 and 1987. All participants had survived testicular cancer for at least 5 years.
Hauptmann and colleagues identified 92 testicular cancer survivors who subsequently were diagnosed with stomach cancer. Median age at diagnosis was 58 years (range, 31-80).
Researchers compared those diagnosed with stomach cancer to 180 matched controls. Two-thirds (67%) of cohort had been treated for seminoma, and nearly all (92%) had either stage I or stage II disease at the time of diagnosis.
The majority of individuals in both groups (80% of cases vs. 78% of controls) underwent surgery and radiotherapy for testicular cancer (80% of cases vs. 78% of controls).
Results showed the cumulative incidence of a second primary invasive stomach cancer was 0.3% (95% CI, 0.2-0.39) at 15 years and 1.45% (95% CI, 1.15-1.74) at 30 years after testicular cancer diagnosis. More than one-third (37%) of stomach cancers were diagnosed ≥20 years after testicular cancer diagnosis.
Hauptmann and colleagues determined individuals who underwent radiotherapy for testicular cancer had a 5.9-fold (95% CI, 1.7-20.7) increased risk for stomach cancer compared with those who did not receive radiotherapy.
Researchers observed a correlation between increased stomach cancer risk and higher radiotherapy dose to the stomach tumor site (P<.001). Those who received ≥50 Gy demonstrated a 20.5-fold (95% CI, 3.7-114.3) increased risk for stomach cancer compared with those who received doses less than 10 Gy.
Radiation-related risks remained elevated for 20 or more years after exposure (P<.001).
The proportion of testicular cancer patients who receive radiotherapy has decreased substantially over the past 20 years. Approximately one-third of patients with seminoma still may receive it, although Hauptmann and colleagues noted fields and doses used are smaller than those used in their study.
Still, the results suggest clinicians need to be aware of the potential risks when radiotherapy is considered for patients with newly diagnosed testicular cancer, researchers wrote.
“Screening recommendations for stomach cancer among testicular cancer survivors are not established,” Hauptmann said. “More research is needed into the risks and benefits of potential screening regimens, and we hope that the data we provide on both the relative and absolute risks will be a valuable contribution to that research.”
Disclosure: The researchers report no relevant financial disclosures.
Michael Hauptmann, PhD, can be reached at m.hauptmann@nki.nl.
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