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Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer.

Abstract

PURPOSE

To compare radiotherapy and chemotherapy effects on long-term risks of second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) in testicular cancer (TC) survivors.

PATIENTS AND METHODS

In our nationwide cohort comprising 2,707 5-year TC survivors, incidences of SMNs and CVDs were compared with general-population rates by calculating standardized incidence ratios (SIRs) and absolute excess risks (AERs). Treatment effects on risks of SMN and CVD were quantified in multivariable Cox regression and competing risks analyses.

RESULTS

After a median follow-up time of 17.6 years, 270 TC survivors developed SMNs. The SIR of SMN overall was 1.7 (95% CI, 1.5 to 1.9), with an AER of 32.3 excess occurrences per 10,000 person-years. SMN risk was 2.6-fold (95% CI, 1.7- to 4.0-fold) increased after subdiaphragmatic radiotherapy and 2.1-fold (95% CI, 1.4- to 3.1-fold) increased after chemotherapy, compared with surgery only. Subdiaphragmatic radiotherapy increased the risk of a major late complication (SMN or CVD) 1.8-fold (95% CI, 1.3- to 2.4-fold), chemotherapy increased the risk of a major late complication 1.9-fold (95% CI, 1.4- to 2.5-fold), and smoking increased the risk of a major late complication 1.7-fold (95% CI, 1.4- to 2.1-fold), compared with surgery only. The median survival time was 1.4 years after SMN and 4.7 years after CVD.

CONCLUSION

Radiotherapy and chemotherapy increased the risk of developing SMN or CVD to a similar extent as smoking. Subdiaphragmatic radiotherapy strongly increases the risk of SMNs but not of CVD, whereas chemotherapy increases the risks of both SMNs and CVDs. Prolonged follow-up after chemotherapy is needed to reliably compare the late complications of radiotherapy and chemotherapy after 20 years.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.

    , , , , , , , ,

    Source

    MeSH

    Adult
    Aged
    Antineoplastic Agents
    Cardiovascular Diseases
    Cisplatin
    Combined Modality Therapy
    Follow-Up Studies
    Humans
    Incidence
    Male
    Middle Aged
    Multivariate Analysis
    Neoplasms, Radiation-Induced
    Neoplasms, Second Primary
    Netherlands
    Proportional Hazards Models
    Radiotherapy
    Risk
    Survivors
    Testicular Neoplasms

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17906202

    Citation

    van den Belt-Dusebout, Alexandra W., et al. "Treatment-specific Risks of Second Malignancies and Cardiovascular Disease in 5-year Survivors of Testicular Cancer." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 25, no. 28, 2007, pp. 4370-8.
    van den Belt-Dusebout AW, de Wit R, Gietema JA, et al. Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2007;25(28):4370-8.
    van den Belt-Dusebout, A. W., de Wit, R., Gietema, J. A., Horenblas, S., Louwman, M. W., Ribot, J. G., ... van Leeuwen, F. E. (2007). Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 25(28), pp. 4370-8.
    van den Belt-Dusebout AW, et al. Treatment-specific Risks of Second Malignancies and Cardiovascular Disease in 5-year Survivors of Testicular Cancer. J Clin Oncol. 2007 Oct 1;25(28):4370-8. PubMed PMID: 17906202.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. AU - van den Belt-Dusebout,Alexandra W, AU - de Wit,Ronald, AU - Gietema,Jourik A, AU - Horenblas,Simon, AU - Louwman,Marieke W J, AU - Ribot,Jacques G, AU - Hoekstra,Harald J, AU - Ouwens,Gabey M, AU - Aleman,Berthe M P, AU - van Leeuwen,Flora E, PY - 2007/10/2/pubmed PY - 2007/10/19/medline PY - 2007/10/2/entrez SP - 4370 EP - 8 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 25 IS - 28 N2 - PURPOSE: To compare radiotherapy and chemotherapy effects on long-term risks of second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) in testicular cancer (TC) survivors. PATIENTS AND METHODS: In our nationwide cohort comprising 2,707 5-year TC survivors, incidences of SMNs and CVDs were compared with general-population rates by calculating standardized incidence ratios (SIRs) and absolute excess risks (AERs). Treatment effects on risks of SMN and CVD were quantified in multivariable Cox regression and competing risks analyses. RESULTS: After a median follow-up time of 17.6 years, 270 TC survivors developed SMNs. The SIR of SMN overall was 1.7 (95% CI, 1.5 to 1.9), with an AER of 32.3 excess occurrences per 10,000 person-years. SMN risk was 2.6-fold (95% CI, 1.7- to 4.0-fold) increased after subdiaphragmatic radiotherapy and 2.1-fold (95% CI, 1.4- to 3.1-fold) increased after chemotherapy, compared with surgery only. Subdiaphragmatic radiotherapy increased the risk of a major late complication (SMN or CVD) 1.8-fold (95% CI, 1.3- to 2.4-fold), chemotherapy increased the risk of a major late complication 1.9-fold (95% CI, 1.4- to 2.5-fold), and smoking increased the risk of a major late complication 1.7-fold (95% CI, 1.4- to 2.1-fold), compared with surgery only. The median survival time was 1.4 years after SMN and 4.7 years after CVD. CONCLUSION: Radiotherapy and chemotherapy increased the risk of developing SMN or CVD to a similar extent as smoking. Subdiaphragmatic radiotherapy strongly increases the risk of SMNs but not of CVD, whereas chemotherapy increases the risks of both SMNs and CVDs. Prolonged follow-up after chemotherapy is needed to reliably compare the late complications of radiotherapy and chemotherapy after 20 years. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/17906202/Treatment_specific_risks_of_second_malignancies_and_cardiovascular_disease_in_5_year_survivors_of_testicular_cancer_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2006.10.5296?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -