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

Journal Article · Tue Dec 01 00:00:00 EST 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.01.073· OSTI ID:21367551

Belt-Dusebout, Alexandra W. van den ^[1]; Aleman, Berthe M.P. ^[2]; Besseling, Gijs; Bruin, Marie L. de ^[1]; Hauptmann, Michael ^[3]; Veer, Mars B. van't ^[4]; Wit, Ronald de ^[5]; Ribot, Jacques G ^[6]; Noordijk, Evert M ^[7]; Kerst, J Martijn ^[8]; Gietema, Jourik A ^[9]; Leeuwen, Flora E. van, ^[10]

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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)

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.

• OSTI ID: 21367551
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 75, 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.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

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