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).Conclusion: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.

“Hockey Stick” may Strike Back: Hepatocellular Carcinoma on Noncirrhotic Liver as a Late Toxicity of Lombo-Aortic Radiotherapy for Seminoma. A Review Triggered by an Unusual Case

“…[16][17][18] On the other hand, the incidence of secondary malignancies among testicular germ cell tumor (TGCT) survivors is higher compared to the general population. 19 However, among all second cancers described, liver tumors are seldom reported.…”

“…In 2013, Horwich et al 17 gathered British data on postradiotherapy outcome for patients treated for stage KORENBAUM ET AL HEPATOCELLULAR CARCINOMA AS A TOXICITY OF LOMBO-AORTIC RADIOTHERAPY FOR SEMINOMA I seminoma between 1960 and 1992 when adjuvant radiotherapy or adjuvant carboplatin was a standard. They found a significant excess risk of second cancer within the pelvic and abdominal radiation field, contrasting with no such increase organs elsewhere.…”

“…The overall cure rate can be very high. 17 Most patients are young at the time of diagnosis. With right treatment plan, patients can be cured off from cancer and their life expectancy meets general population data.…”

Treatment of Stage I Seminoma

“…24 The long-term toxicity which is of concern are second malignancy and cardiac toxicity. 28,29 In a larger series, though the cardiovascular toxicity was not high, second malignancies were reported more.…”

Long-term Relative Survival after Diagnosis of Testicular Germ Cell Tumor

“…Despite today's excellent 10-year survival rates of above 95%, TGCT treatment is associated with an increased risk of potentially life-threatening late effects. The most important are second malignant neoplasms and cardiovascular disease, usually manifesting beyond 10 years of follow-up (1)(2)(3)(4)(5)(6)(7)(8). Even more alarming are the reports on increased mortality from these and other conditions in TGCT survivors (1-4, 9, 10).…”