학술논문
Stomach Cancer Following Hodgkin Lymphoma, Testicular Cancer and Cervical Cancer: A Pooled Analysis of Three International Studies with a Focus on Radiation Effects.
Document Type
Academic Journal
Author
Gilbert ES; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Curtis RE; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Hauptmann M; b Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.; Kleinerman RA; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Lynch CF; c Department of Epidemiology, University of Iowa, Iowa City, Iowa.; Stovall M; d Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas.; Smith SA; d Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas.; Weathers R; d Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas.; Andersson M; e Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.; Dores GM; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Fraumeni JF Jr; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Fossa SD; f Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway.; Hall P; g Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.; Hodgson DC; h Department of Radiation Oncology, University of Toronto, Toronto, Canada.; Holowaty EJ; i Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.; Joensuu H; j Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.; Johannesen TB; k Cancer Registry of Norway, Oslo, Norway.; Langmark F; k Cancer Registry of Norway, Oslo, Norway.; Kaijser M; l Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.; Pukkala E; m Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.; n School of Health Sciences, University of Tampere, Tampere, Finland.; Rajaraman P; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; Storm HH; Danish Cancer Society, Copenhagen, Denmark.; Vaalavirta L; j Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.; van den Belt-Dusebout AW; b Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.; Aleman BM; p Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; and.; Travis LB; q Melvin and Bren Simon Cancer Center, Indianapolis University School of Medicine, Indianapolis, Indiana.; Morton LM; a Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland.; van Leeuwen FE; b Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Source
Publisher: Radiation Research Society Country of Publication: United States NLM ID: 0401245 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-5404 (Electronic) Linking ISSN: 00337587 NLM ISO Abbreviation: Radiat Res Subsets: MEDLINE
Subject
Language
English
Abstract
To further understand the risk of stomach cancer after fractionated high-dose radiotherapy, we pooled individual-level data from three recent stomach cancer case-control studies. These studies were nested in cohorts of five-year survivors of first primary Hodgkin lymphoma (HL), testicular cancer (TC) or cervical cancer (CX) from seven countries. Detailed data were abstracted from patient records and radiation doses were reconstructed to the site of the stomach cancer for cases and to the corresponding sites for matched controls. Among 327 cases and 678 controls, mean doses to the stomach were 15.3 Gy, 24.7 Gy and 1.9 Gy, respectively, for Hodgkin lymphoma, testicular cancer and cervical cancer survivors, with an overall mean dose of 10.3 Gy. Risk increased with increasing radiation dose to the stomach cancer site (P < 0.001) with no evidence of nonlinearity or of a downturn at the highest doses (≥35 Gy). The pooled excess odds ratio per Gy (EOR/Gy) was 0.091 [95% confidence interval (CI): 0.036-0.20] with estimates of 0.049 (95% CI: 0.007-0.16) for Hodgkin lymphoma, 0.27 (95% CI: 0.054-1.44) for testicular cancer and 0.096 (95% CI: -0.002-0.39) for cervical cancer (P homogeneity = 0.25). The EOR/Gy increased with time since exposure (P trend = 0.004), with an EOR/Gy of 0.38 (95% CI: 0.12-1.04) for stomach cancer occurring ≥20 years postirradiation corresponding to odds ratios of 4.8 and 10.5 at radiation doses to the stomach of 10 and 25 Gy, respectively. Of 111 stomach cancers occurring ≥20 years after radiotherapy, 63.8 (57%) could be attributed to radiotherapy. Our findings differ from those based on Japanese atomic-bomb survivors, where the overall EOR/Gy was higher and where there was no evidence of an increase with time since exposure. By pooling data from three studies, we demonstrated a clear increase in stomach cancer risk over a wide range of doses from fractionated radiotherapy with the highest risks occurring many years after exposure. These findings highlight the need to directly evaluate the health effects of high-dose fractionated radiotherapy rather than relying on the data of persons exposed at low and moderate acute doses.