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Br J Cancer. 2016 Sep 27;115(7):901-8. doi: 10.1038/bjc.2016.272. Epub 2016 Sep 6.

Increased pancreatic cancer risk following radiotherapy for testicular cancer.

Author information

1
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
2
Cancer Registry of Norway, Oslo, Norway.
3
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
4
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
6
Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
7
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
8
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
9
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
10
Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
11
Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
12
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
13
School of Health Sciences, University of Tampere, Tampere, Finland.
14
Danish Cancer Society, Copenhagen, Denmark.
15
Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway.
16
Melvin and Bren Simon Cancer Center, Indianapolis University School of Medicine, Indianapolis, IN, USA.

Abstract

BACKGROUND:

Pancreatic cancer risk is elevated among testicular cancer (TC) survivors. However, the roles of specific treatments are unclear.

METHODS:

Among 23 982 5-year TC survivors diagnosed during 1947-1991, doses from radiotherapy to the pancreas were estimated for 80 pancreatic cancer patients and 145 matched controls. Chemotherapy details were recorded. Logistic regression was used to estimate odds ratios (ORs).

RESULTS:

Cumulative incidence of second primary pancreatic cancer was 1.1% at 30 years after TC diagnosis. Radiotherapy (72 (90%) cases and 115 (80%) controls) was associated with a 2.9-fold (95% confidence interval (CI) 1.0-7.8) increased risk. The OR increased linearly by 0.12 per Gy to the pancreas (P-trend<0.001), with an OR of 4.6 (95% CI 1.9-11.0) for ⩾25 Gy vs <25 Gy. Radiation-related risks remained elevated ⩾20 years after TC diagnosis (P=0.020). The risk increased with the number of cycles of chemotherapy with alkylating or platinum agents (P=0.057), although only one case was exposed to platinum.

CONCLUSIONS:

A dose-response relationship exists between radiation to the pancreas and subsequent cancer risk, and persists for over 20 years. These excesses, although small, should be considered when radiotherapy with exposure to the pancreas is considered for newly diagnosed patients. Additional data are needed on the role of chemotherapy.

PMID:
27599043
PMCID:
PMC5046216
DOI:
10.1038/bjc.2016.272
[Indexed for MEDLINE]
Free PMC Article

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