title: Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.affiliation: Norwegian Radium Hospital, Oslo, Norway.
authors.forename: S D
authors.initials: SD
authors.lastname: Fossa
authors.affiliation: Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: R
authors.initials: R
authors.lastname: Huddart
authors.affiliation: Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
authors.affiliation: The Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
authors.forename: S
authors.initials: S
authors.lastname: Stenning
authors.affiliation: The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: M
authors.initials: M
authors.lastname: Aresu
authors.affiliation: The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Bliss
authors.affiliation: The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hall
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology*; D009664:Norway / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*; D006113:United Kingdom / Q000453:epidemiology