title: Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer.
abstract: OBJECTIVE
  To assess the dose-response relationship for stomach cancer after radiation therapy for cervical cancer.
  
  
  METHODS
  We conducted a nested, matched case-control study of 201 cases and 378 controls among 53,547 5-year survivors of cervical cancer diagnosed from 1943 to 1995, from 5 international, population-based cancer registries. We estimated individual radiation doses to the site of the stomach cancer for all cases and to corresponding sites for the matched controls (overall mean stomach tumor dose, 2.56 Gy, range 0.03-46.1 and after parallel opposed pelvic fields, 1.63 Gy, range 0.12-6.3).
  
  
  RESULTS
  More than 90% of women received radiation therapy, mostly with external beam therapy in combination with brachytherapy. Stomach cancer risk was nonsignificantly increased (odds ratio 1.27-2.28) for women receiving between 0.5 and 4.9 Gy to the stomach cancer site and significantly increased at doses ≥ 5 Gy (odds ratio 4.20, 95% confidence interval 1.41-13.4, Ptrend=.047) compared with nonirradiated women. A highly significant radiation dose-response relationship was evident when analyses were restricted to the 131 cases (251 controls) whose stomach cancer was located in the middle and lower portions of the stomach (Ptrend=.003), whereas there was no indication of increasing risk with increasing dose for 30 cases (57 controls) whose cancer was located in the upper stomach (Ptrend=.23).
  
  
  CONCLUSIONS
  Our findings show for the first time a significant linear dose-response relationship for risk of stomach cancer in long-term survivors of cervical cancer.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland, USA. kleinerr@mail.nih.gov
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Kleinerman
authors.forename: Susan A
authors.initials: SA
authors.lastname: Smith
authors.forename: Eric
authors.initials: E
authors.lastname: Holowaty
authors.forename: Per
authors.initials: P
authors.lastname: Hall
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Leila
authors.initials: L
authors.lastname: Vaalavirta
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Rita
authors.initials: R
authors.lastname: Weathers
authors.forename: Ethel
authors.initials: E
authors.lastname: Gilbert
authors.forename: Berthe M P
authors.initials: BM
authors.lastname: Aleman
authors.forename: Magnus
authors.initials: M
authors.lastname: Kaijser
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
authors.forename: Hans
authors.initials: H
authors.lastname: Storm
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Graça M
authors.initials: GM
authors.lastname: Dores
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Morton
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016001:Confidence Intervals; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000473:pathology; D016017:Odds Ratio; D011879:Radiotherapy Dosage; D012042:Registries / Q000706:statistics & numerical data; D012306:Risk; D013274:Stomach Neoplasms / Q000209:etiology* / Q000473:pathology; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*