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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.

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