Risk of diabetes after para-aortic radiation for testicular cancer

• Published in: British journal of cancer Vol. 119; no. 7; pp. 901 - 907
• Main Authors: Groot, Harmke J., Gietema, Jourik A., Aleman, Berthe M. P., Incrocci, Luca, de Wit, Ronald, Witjes, J. Alfred, Groenewegen, Gerard, de Brouwer, Peter, Meijer, Otto W. M., Hulshof, Maarten C. C. M., van den Berg, Hetty A., Smilde, Tineke J., Vanneste, Ben G. L., Aarts, Maureen J., van den Bergh, Alphonsus C. M., Kerst, J. Martijn, van den Belt-Dusebout, Alexandra W., Lubberts, Sjoukje, Jóźwiak, Katarzina, Horenblas, Simon, van Leeuwen, Flora E., Schaapveld, Michael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 02.10.2018; Nature Publishing Group
• Subjects: 692/308/174; 692/4028/67/1836; 692/699/2743/137/773; Adult; Aorta; Background radiation; Biomedical and Life Sciences; Biomedicine; Body mass; Cancer; Cancer Research; Cancer Survivors - statistics & numerical data; Children; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Dose-Response Relationship, Radiation; Drug Resistance; Epidemiology; Health risk assessment; Health risks; Humans; Incidence; Irradiation; Male; Molecular Medicine; Oncology; Orchidectomy; Orchiectomy; Pancreas; Pancreatic cancer; Radiation; Radiation therapy; Radiotherapy - adverse effects; Surgery; Testes; Testicular cancer; Testicular Neoplasms - radiotherapy; Testicular Neoplasms - surgery; Treatment Outcome
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-018-0248-x

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.