Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J. Groot; Jourik A. Gietema; Berthe M. P. Aleman; Luca Incrocci; Ronald de Wit; J. Alfred Witjes; Gerard Groenewegen; Peter de Brouwer; Otto W. M. Meijer; Maarten C. C. M. Hulshof; Hetty A. van den Berg; Tineke J. Smilde; Ben G. L. Vanneste; Maureen J. Aarts; Alphonsus C. M. van den Bergh; J. Martijn Kerst; Alexandra W. van den Belt-Dusebout; Sjoukje Lubberts; Katarzina Jozwiak; Simon Horenblas; Flora E. van Leeuwen; Michael Schaapveld

doi:10.1038/s41416-018-0248-x

Risk of diabetes after para-aortic radiation for testicular cancer

Harmke J. Groot
, Jourik A. Gietema
, Berthe M. P. Aleman
, Luca Incrocci
, Ronald de Wit
, J. Alfred Witjes
, Gerard Groenewegen
, Peter de Brouwer
, Otto W. M. Meijer
, Maarten C. C. M. Hulshof
, Hetty A. van den Berg
, Tineke J. Smilde
, Ben G. L. Vanneste
, Maureen J. Aarts
, Alphonsus C. M. van den Bergh
, J. Martijn Kerst
, Alexandra W. van den Belt-Dusebout
, Sjoukje Lubberts
, Katarzina Jozwiak
, Simon Horenblas

Flora E. van Leeuwen, Michael Schaapveld^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.

METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.

RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.

CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

Original language	English
Pages (from-to)	901-907
Number of pages	7
Journal	British Journal of Cancer
Volume	119
Issue number	7
DOIs	https://doi.org/10.1038/s41416-018-0248-x
Publication status	Published - 2 Oct 2018

Keywords

STAGE-I SEMINOMA
LONG-TERM SURVIVORS
GERM-CELL CANCER
FOLLOW-UP
CARDIOVASCULAR-DISEASE
A-REPORT
MELLITUS
SURVEILLANCE
RADIOTHERAPY
CARBOPLATIN

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Groot, H. J., Gietema, J. A., Aleman, B. M. P., Incrocci, L., de Wit, R., Witjes, J. A., Groenewegen, G., de Brouwer, P., Meijer, O. W. M., Hulshof, M. C. C. M., van den Berg, H. A., Smilde, T. J., Vanneste, B. G. L., Aarts, M. J., van den Bergh, A. C. M., Kerst, J. M., van den Belt-Dusebout, A. W., Lubberts, S., Jozwiak, K., ... Schaapveld, M. (2018). Risk of diabetes after para-aortic radiation for testicular cancer. British Journal of Cancer, 119(7), 901-907. https://doi.org/10.1038/s41416-018-0248-x

@article{33db01a2fd5b4dbbabd256eebf5e21a4,

title = "Risk of diabetes after para-aortic radiation for testicular cancer",

abstract = "BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95\% confidence interval (95\% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95\% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95\% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95\% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.",

keywords = "STAGE-I SEMINOMA, LONG-TERM SURVIVORS, GERM-CELL CANCER, FOLLOW-UP, CARDIOVASCULAR-DISEASE, A-REPORT, MELLITUS, SURVEILLANCE, RADIOTHERAPY, CARBOPLATIN",

author = "Groot, \{Harmke J.\} and Gietema, \{Jourik A.\} and Aleman, \{Berthe M. P.\} and Luca Incrocci and \{de Wit\}, Ronald and Witjes, \{J. Alfred\} and Gerard Groenewegen and \{de Brouwer\}, Peter and Meijer, \{Otto W. M.\} and Hulshof, \{Maarten C. C. M.\} and \{van den Berg\}, \{Hetty A.\} and Smilde, \{Tineke J.\} and Vanneste, \{Ben G. L.\} and Aarts, \{Maureen J.\} and \{van den Bergh\}, \{Alphonsus C. M.\} and Kerst, \{J. Martijn\} and \{van den Belt-Dusebout\}, \{Alexandra W.\} and Sjoukje Lubberts and Katarzina Jozwiak and Simon Horenblas and \{van Leeuwen\}, \{Flora E.\} and Michael Schaapveld",

year = "2018",

month = oct,

day = "2",

doi = "10.1038/s41416-018-0248-x",

language = "English",

volume = "119",

pages = "901--907",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer",

number = "7",

}

Groot, HJ, Gietema, JA, Aleman, BMP, Incrocci, L, de Wit, R, Witjes, JA, Groenewegen, G, de Brouwer, P, Meijer, OWM, Hulshof, MCCM, van den Berg, HA, Smilde, TJ, Vanneste, BGL, Aarts, MJ, van den Bergh, ACM, Kerst, JM, van den Belt-Dusebout, AW, Lubberts, S, Jozwiak, K, Horenblas, S, van Leeuwen, FE & Schaapveld, M 2018, 'Risk of diabetes after para-aortic radiation for testicular cancer', British Journal of Cancer, vol. 119, no. 7, pp. 901-907. https://doi.org/10.1038/s41416-018-0248-x

TY - JOUR

T1 - Risk of diabetes after para-aortic radiation for testicular cancer

AU - Groot, Harmke J.

AU - Gietema, Jourik A.

AU - Aleman, Berthe M. P.

AU - Incrocci, Luca

AU - de Wit, Ronald

AU - Witjes, J. Alfred

AU - Groenewegen, Gerard

AU - de Brouwer, Peter

AU - Meijer, Otto W. M.

AU - Hulshof, Maarten C. C. M.

AU - van den Berg, Hetty A.

AU - Smilde, Tineke J.

AU - Vanneste, Ben G. L.

AU - Aarts, Maureen J.

AU - van den Bergh, Alphonsus C. M.

AU - Kerst, J. Martijn

AU - van den Belt-Dusebout, Alexandra W.

AU - Lubberts, Sjoukje

AU - Jozwiak, Katarzina

AU - Horenblas, Simon

AU - van Leeuwen, Flora E.

AU - Schaapveld, Michael

PY - 2018/10/2

Y1 - 2018/10/2

N2 - BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

AB - BACKGROUND: While the risk of diabetes is increased following radiation exposure to the pancreas among childhood cancer survivors, its association among testicular cancer (TC) survivors has not been investigated.METHODS: Diabetes risk was studied in 2998 1-year TC survivors treated before 50 years of age with orchidectomy with/without radiotherapy between 1976 and 2007. Diabetes incidence was compared with general population rates. Treatment-specific risk of diabetes was assessed using a case-cohort design.RESULTS: With a median follow-up of 13.4 years, 161 TC survivors were diagnosed with diabetes. Diabetes risk was not increased compared to general population rates (standardised incidence ratios (SIR): 0.9; 95% confidence interval (95% CI): 0.7-1.1). Adjusted for age, para-aortic radiotherapy was associated with a 1.66-fold (95% CI: 1.05-2.62) increased diabetes risk compared to no radiotherapy. The excess hazard increased with 0.31 with every 10 Gy increase in the prescribed radiation dose (95% CI: 0.11-0.51, P = 0.003, adjusted for age and BMI); restricted to irradiated patients the excess hazard increased with 0.33 (95% CI:-0.14 to 0.81, P = 0.169) with every 10 Gy increase in radiation dose.CONCLUSION: Compared to surgery only, para-aortic irradiation is associated with increased diabetes risk among TC survivors.

KW - STAGE-I SEMINOMA

KW - LONG-TERM SURVIVORS

KW - GERM-CELL CANCER

KW - FOLLOW-UP

KW - CARDIOVASCULAR-DISEASE

KW - A-REPORT

KW - MELLITUS

KW - SURVEILLANCE

KW - RADIOTHERAPY

KW - CARBOPLATIN

U2 - 10.1038/s41416-018-0248-x

DO - 10.1038/s41416-018-0248-x

M3 - Article

SN - 0007-0920

VL - 119

SP - 901

EP - 907

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 7

ER -

Risk of diabetes after para-aortic radiation for testicular cancer

Abstract

Keywords

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