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Title: Roles of Radiation Dose and Chemotherapy in the Etiology of Stomach Cancer as a Second Malignancy

Abstract

Purpose: To evaluate the roles of radiation dose, chemotherapy, and other factors in the etiology of stomach cancer in long-term survivors of testicular cancer or Hodgkin lymphoma. Methods and Materials: We conducted a cohort study in 5,142 survivors of testicular cancer or Hodgkin lymphoma treated in the Netherlands between 1965 and 1995. In a nested case-control study, detailed information on treatment, smoking, gastrointestinal diseases, and family history was collected for 42 patients with stomach cancer and 126 matched controls. For each subject, the mean radiation dose to the stomach was estimated. Relative risks (RRs) of stomach cancer and the radiation-related excess relative risk (ERR) per gray were calculated by conditional logistic regression analysis. Results: The risk of stomach cancer was 3.4-fold increased compared with the general population. The risk increased with increasing mean stomach dose (p for trend, <0.001), at an ERR of 0.84 per Gy (95% confidence interval [CI], 0.12-15.6). Mean stomach doses of more than 20 Gy were associated with a RR of 9.9 (95% CI, 3.2-31.2) compared with doses below 11 Gy. The risk was 1.8-fold (95% CI, 0.8-4.4) increased after chemotherapy and 5.4-fold (95% CI, 1.2-23.9) increased after high doses of procarbazine (>=13,000 mg) vs. <10,000more » mg. The RR of smoking more than 10 cigarettes per day vs. no smoking was 1.6 (95% CI, 0.6-4.2). Conclusions: Stomach cancer risk is strongly radiation dose dependent. The role of chemotherapy, particularly of procarbazine and related agents, needs further study, because of the relatively small numbers of chemotherapy-treated subjects.« less

Authors:
 [1];  [2]; ;  [1];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10]
  1. Department of Epidemiology, Netherlands Cancer Institute, Amsterdam (Netherlands)
  2. Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam (Netherlands)
  3. Department of Bioinformatics and Statistics, Netherlands Cancer Institute, Amsterdam (Netherlands)
  4. Department of Hematology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)
  5. Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)
  6. Department of Radiotherapy, Catharina Hospital, Eindhoven (Netherlands)
  7. Department of Radiotherapy, Leiden University Medical Center, Leiden (Netherlands)
  8. Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam (Netherlands)
  9. Department of Medical Oncology, University Medical Center Groningen, Groningen (Netherlands)
  10. Department of Epidemiology, the Netherlands Cancer Institute, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
21367551
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 75; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2009.01.073; PII: S0360-3016(09)00105-9; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; DOSE-RESPONSE RELATIONSHIPS; ETIOLOGY; HEALTH HAZARDS; HODGKINS DISEASE; RADIATION DOSES; REGRESSION ANALYSIS; STOMACH; TESTES; BODY; DIGESTIVE SYSTEM; DISEASES; DOSES; GASTROINTESTINAL TRACT; GONADS; HAZARDS; IMMUNE SYSTEM DISEASES; LYMPHOMAS; MALE GENITALS; MATHEMATICS; MEDICINE; NEOPLASMS; ORGANS; STATISTICS; THERAPY

Citation Formats

Belt-Dusebout, Alexandra W. van den, Aleman, Berthe M.P., Besseling, Gijs, Bruin, Marie L. de, Hauptmann, Michael, Veer, Mars B. van't, Wit, Ronald de, Ribot, Jacques G., Noordijk, Evert M., Kerst, J. Martijn, Gietema, Jourik A., and Leeuwen, Flora E. van, E-mail: f.v.leeuwen@nki.n. Roles of Radiation Dose and Chemotherapy in the Etiology of Stomach Cancer as a Second Malignancy. United States: N. p., 2009. Web. doi:10.1016/j.ijrobp.2009.01.073.
Belt-Dusebout, Alexandra W. van den, Aleman, Berthe M.P., Besseling, Gijs, Bruin, Marie L. de, Hauptmann, Michael, Veer, Mars B. van't, Wit, Ronald de, Ribot, Jacques G., Noordijk, Evert M., Kerst, J. Martijn, Gietema, Jourik A., & Leeuwen, Flora E. van, E-mail: f.v.leeuwen@nki.n. Roles of Radiation Dose and Chemotherapy in the Etiology of Stomach Cancer as a Second Malignancy. United States. doi:10.1016/j.ijrobp.2009.01.073.
Belt-Dusebout, Alexandra W. van den, Aleman, Berthe M.P., Besseling, Gijs, Bruin, Marie L. de, Hauptmann, Michael, Veer, Mars B. van't, Wit, Ronald de, Ribot, Jacques G., Noordijk, Evert M., Kerst, J. Martijn, Gietema, Jourik A., and Leeuwen, Flora E. van, E-mail: f.v.leeuwen@nki.n. Tue . "Roles of Radiation Dose and Chemotherapy in the Etiology of Stomach Cancer as a Second Malignancy". United States. doi:10.1016/j.ijrobp.2009.01.073.
@article{osti_21367551,
title = {Roles of Radiation Dose and Chemotherapy in the Etiology of Stomach Cancer as a Second Malignancy},
author = {Belt-Dusebout, Alexandra W. van den and Aleman, Berthe M.P. and Besseling, Gijs and Bruin, Marie L. de and Hauptmann, Michael and Veer, Mars B. van't and Wit, Ronald de and Ribot, Jacques G. and Noordijk, Evert M. and Kerst, J. Martijn and Gietema, Jourik A. and Leeuwen, Flora E. van, E-mail: f.v.leeuwen@nki.n},
abstractNote = {Purpose: To evaluate the roles of radiation dose, chemotherapy, and other factors in the etiology of stomach cancer in long-term survivors of testicular cancer or Hodgkin lymphoma. Methods and Materials: We conducted a cohort study in 5,142 survivors of testicular cancer or Hodgkin lymphoma treated in the Netherlands between 1965 and 1995. In a nested case-control study, detailed information on treatment, smoking, gastrointestinal diseases, and family history was collected for 42 patients with stomach cancer and 126 matched controls. For each subject, the mean radiation dose to the stomach was estimated. Relative risks (RRs) of stomach cancer and the radiation-related excess relative risk (ERR) per gray were calculated by conditional logistic regression analysis. Results: The risk of stomach cancer was 3.4-fold increased compared with the general population. The risk increased with increasing mean stomach dose (p for trend, <0.001), at an ERR of 0.84 per Gy (95% confidence interval [CI], 0.12-15.6). Mean stomach doses of more than 20 Gy were associated with a RR of 9.9 (95% CI, 3.2-31.2) compared with doses below 11 Gy. The risk was 1.8-fold (95% CI, 0.8-4.4) increased after chemotherapy and 5.4-fold (95% CI, 1.2-23.9) increased after high doses of procarbazine (>=13,000 mg) vs. <10,000 mg. The RR of smoking more than 10 cigarettes per day vs. no smoking was 1.6 (95% CI, 0.6-4.2). Conclusions: Stomach cancer risk is strongly radiation dose dependent. The role of chemotherapy, particularly of procarbazine and related agents, needs further study, because of the relatively small numbers of chemotherapy-treated subjects.},
doi = {10.1016/j.ijrobp.2009.01.073},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 75,
place = {United States},
year = {2009},
month = {12}
}