title: Increased stomach cancer risk following radiotherapy for testicular cancer.
abstract: BACKGROUND
  Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse.
  
  
  METHODS
  In a cohort of 22,269 5-year TC survivors diagnosed during 1959-1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression.
  
  
  RESULTS
  Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7-20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7-114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5-2.5; 14 cases and 23 controls).
  
  
  CONCLUSIONS
  Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.
authors.affiliation: Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hauptmann
authors.affiliation: Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: S D
authors.initials: SD
authors.lastname: Fossa
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Stovall
authors.affiliation: Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: F E
authors.initials: FE
authors.lastname: van Leeuwen
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: T B
authors.initials: TB
authors.lastname: Johannesen
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: P
authors.initials: P
authors.lastname: Rajaraman
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Gilbert
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Weathers
authors.affiliation: 1] Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands [2] Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: B M P
authors.initials: BM
authors.lastname: Aleman
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Andersson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Curtis
authors.affiliation: 1] Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA [2] Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Dores
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Fraumeni
authors.affiliation: 1] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden [2] Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Hall
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: E J
authors.initials: EJ
authors.lastname: Holowaty
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Joensuu
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Kaijser
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Kleinerman
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: F
authors.initials: F
authors.lastname: Langmark
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: 1] Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland [2] School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Pukkala
authors.affiliation: Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: H H
authors.initials: HH
authors.lastname: Storm
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Vaalavirta
authors.affiliation: Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: van den Belt-Dusebout
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Travis
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Morton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D011879:Radiotherapy Dosage; D013274:Stomach Neoplasms / Q000209:etiology*; D017741:Survivors; D013736:Testicular Neoplasms / Q000532:radiotherapy*; D055815:Young Adult