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Br J Cancer. 2014 Jan 7;110(1):256-63. doi: 10.1038/bjc.2013.551. Epub 2013 Nov 21.

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma.

Author information

  • 1Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK.
  • 2Norwegian Radium Hospital, Oslo, Norway.
  • 3The Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
  • 4The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK.



Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant.


We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51,151 person-years of follow-up.


Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47-1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39-1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic-abdominal sites the SIR was 1.62 (95% CI: 1.43-1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98-1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30-1.65, P<0.0001).


The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.

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