Abstract
Using complete information on total treatment burden, this population-based study aimed to investigate second cancer (SC) risk in testicular cancer survivors (TCS) treated in the cisplatin era. The Cancer Registry of Norway identified 5,625 1-year TCS diagnosed 1980-2009. Standardized incidence ratios (SIRs) were calculated to evaluate the total and site-specific incidence of SC compared to the general population. Cox regression analyses evaluated the effect of treatment on the risk of SC. After a median observation time of 16.6 years, 572 TCS developed 651 nongerm cell SCs. The SC risk was increased after surgery only (SIR 1.28), with site-specific increased risks of thyroid cancer (SIR 4.95) and melanoma (SIR 1.94). After chemotherapy (CT), we observed 2.0- to 3.7-fold increased risks for cancers of the small intestine, bladder, kidney and lung. There was a 1.6- to 2.1-fold increased risk of SC after ≥2 cycles of cisplatin-based CT. Radiotherapy (RT) was associated with 1.5- to 4.4-fold increased risks for cancers of the stomach, small intestine, liver, pancreas, lung, kidney and bladder. After combined CT and RT, increased risks emerged for hematological malignancies (SIR 3.23). TCS treated in the cisplatin era have an increased risk of developing SC, in particular after treatment with cisplatin-based CT and/or RT.
Highlights
Patients with germ cell testicular cancer (TC) have a 15-year relative survival rate exceeding 98% in Norway.[1]
second cancer (SC) risks were increased after RT doses of ≥20 Gy to the first abdominal field. In this national testicular cancer survivors (TCS) cohort treated since 1980, we found, to the best of our knowledge for the first time, a significantly increased overall risk for nongerm cell SC among TCS treated with surgery only when compared to the general population, with site-specific excess risks of thyroid cancer and melanoma
We demonstrated that contemporary treatment with cisplatin-based chemotherapy (CBCT) leads to a continuing increased risk of SC, with significantly increased site-specific risk of cancers of the small intestine, lung, melanoma, kidney and bladder
Summary
Patients with germ cell testicular cancer (TC) have a 15-year relative survival rate exceeding 98% in Norway.[1]. Previous studies have demonstrated a 1.7 to 3.5-fold increased risk for both hematological and solid nongerm cell SC in testicular cancer survivors (TCS) compared to age-matched general populations.[6,7,8,9] The risk has been associated with both radiotherapy (RT) and chemotherapy (CT), but not with surgery only. The majority of these studies have, been based on outdated
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