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 Jóźwiak; 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 Jóźwiak
, Simon Horenblas

Flora E van Leeuwen, Michael Schaapveld

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
Article number	30297773
Pages (from-to)	901-907
Number of pages	7
Journal	British Journal of Cancer
Volume	119
Issue number	7
Early online date	2018
DOIs	https://doi.org/10.1038/s41416-018-0248-x
Publication status	Published - Oct 2018

Keywords

Adult
Cancer Survivors/statistics & numerical data
Cohort Studies
Diabetes Mellitus/epidemiology
Dose-Response Relationship, Radiation
Humans
Incidence
Male
Orchiectomy
Radiotherapy/adverse effects
Testicular Neoplasms/radiotherapy
Treatment Outcome

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10.1038/s41416-018-0248-x

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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., Jóźwiak, K., ... Schaapveld, M. (2018). Risk of diabetes after para-aortic radiation for testicular cancer. British Journal of Cancer, 119(7), 901-907. Article 30297773. https://doi.org/10.1038/s41416-018-0248-x

@article{d09d6345b2d3411d9e4c4b5d92fba16f,

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 = "Adult, Cancer Survivors/statistics \& numerical data, Cohort Studies, Diabetes Mellitus/epidemiology, Dose-Response Relationship, Radiation, Humans, Incidence, Male, Orchiectomy, Radiotherapy/adverse effects, Testicular Neoplasms/radiotherapy, Treatment Outcome",

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 J{\'o}{\'z}wiak and Simon Horenblas and \{van Leeuwen\}, \{Flora E\} and Michael Schaapveld",

year = "2018",

month = oct,

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

language = "English",

volume = "119",

pages = "901--907",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer Nature",

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, Jóźwiak, 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, 30297773, 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 - Jóźwiak, Katarzina

AU - Horenblas, Simon

AU - van Leeuwen, Flora E

AU - Schaapveld, Michael

PY - 2018/10

Y1 - 2018/10

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 - Adult

KW - Cancer Survivors/statistics & numerical data

KW - Cohort Studies

KW - Diabetes Mellitus/epidemiology

KW - Dose-Response Relationship, Radiation

KW - Humans

KW - Incidence

KW - Male

KW - Orchiectomy

KW - Radiotherapy/adverse effects

KW - Testicular Neoplasms/radiotherapy

KW - Treatment Outcome

UR - https://www.scopus.com/pages/publications/85054557066

U2 - 10.1038/s41416-018-0248-x

DO - 10.1038/s41416-018-0248-x

M3 - Article

C2 - 30297773

SN - 0007-0920

VL - 119

SP - 901

EP - 907

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 7

M1 - 30297773

ER -

Risk of diabetes after para-aortic radiation for testicular cancer

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