Journal
BRITISH JOURNAL OF CANCER
Volume 110, Issue 1, Pages 256-263Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bjc.2013.551
Keywords
seminoma; radiotherapy; carboplatin; metastasis
Categories
Funding
- NHS Executive
- Institute of Cancer Research (ICR)
- Cancer Research UK (CRUK) [C46/A10588, C1491/A9895]
- MRC through its Cancer Therapy Committee
- MRC [MC_U122861331] Funding Source: UKRI
- Cancer Research UK [10588, 15955] Funding Source: researchfish
- Medical Research Council [MC_U122861331] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10106] Funding Source: researchfish
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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.
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