title: Late gastrointestinal morbidity in patients with stage I-II testicular seminoma treated with radiotherapy.
abstract: OBJECTIVE
  To define the incidence and risk factors for late gastrointestinal (GI) morbidity in patients with testicular seminoma treated with radiotherapy (RT).
  
  
  METHODS
  A retrospective review was conducted of 251 patients with stage I or II testicular seminoma treated with curative-intent RT at our institution from 1974 to 2009. All patients underwent orchiectomy and postoperative external beam RT to the involved nodal basin or at-risk nodal basin or both. Potential late GI morbidities that were assessed included endoscopically confirmed peptic ulcer disease (PUD), small bowel obstruction (SBO), and biopsy-confirmed malignancy of the GI tract. The probabilities of these GI morbidities were estimated with the Kaplan-Meier method. Univariate analyses were performed to examine for associated predictive factors using the Cox proportional hazards model.
  
  
  RESULTS
  Median age at diagnosis was 36 years (range 18-80). Clinical stage was I (n = 199) or II (n = 52). Median abdominopelvic RT dose was 26Gy (interquartile range = 25-30). Median follow-up was 15 years (range = 0.1-38). PUD risk at 10, 20, and 30 years was 4%, 7%, and 9%, respectively. Age at diagnosis (per y, HR = 1.05, 95% CI 1.00-1.09, P = 0.04) and RT dose (per Gy, HR = 1.20, 95% CI 1.09-1.31, P<0.01) were associated with risk of PUD. SBO risk at 10, 20, and 30 years was 2%, 2%, and 3%, respectively. History of inflammatory bowel disease was associated with risk of SBO (HR = 43, 95% CI 7-325, P<0.01). GI second malignancy risk at 10, 20, and 30 years was 0.5%, 3% and 16%, respectively. Age at RT was associated with risk of GI malignancy (per y, HR = 1.07, 95% CI 1.02-1.14, P = 0.01).
  
  
  CONCLUSIONS
  In this patient population, late GI morbidity was relatively uncommon, but clinically significant. Refinements of treatment strategies may reduce this risk.
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: hallemeier.christopher@mayo.edu.
authors: Christopher L
authors: CL
authors: Hallemeier
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors: Brian J
authors: BJ
authors: Davis
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors: Thomas M
authors: TM
authors: Pisansky
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors: Richard
authors: R
authors: Choo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
keywords: Radiotherapy; Seminoma; Testicular neoplasms