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Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer.
J Clin Oncol 2007; 25(28):4370-8JC

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.

Authors+Show Affiliations

Department of Epidemiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -