Cancer following radiotherapy for peptic ulcer

Melvin L. Griem, Ruth A. Kleinerman, John D. Boice, Marilyn Stovall, Deborah Shefner, Jay H. Lubin

Research output: Contribution to journalArticle

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Abstract

Background: Radiotherapy for peptic ulcer was used between 1937 and 1965 to control excessive gastric acid secretions (mean dose, 14.8 Gy). Patients with this benign condition live many years after treatment and are at risk for late effects. Purpose: Our purpose was to investigate the risk of death from cancer following radiotherapy for peptic ulcer. Methods: A mortality study was conducted of 3609 patients with peptic ulcer; 1831 were treated with radiation and 1778 were treated by other means. Extensive methods were used to trace patients. Radiation doses to specific organs were reconstructed from the original radiotherapy records. Results: Nearly 70% of patients were found to have died. The average period of observation was 21.5 years (maximum 51 years). Compared with the general population, patients treated with or without radiation were at significantly increased risk of dying of cancer and non-malignant diseases of the digestive system. Risk of death due to heart disease was slightly higher following radiotherapy. Cancers of the stomach, pancreas, lung, and prostate were increased in both irradiated and nonirradiated patients. Radiotherapy was linked to significantly high relative risks (RRs) for all cancers combined (RR = 1.53; 95% confidence interval [CI] = 13-1.8), for cancers of the stomach (RR = 2.77; 95% CI = 1.6-4.8), pancreas (RR = 1.87; 95% CI = 1.0-3.4), and lung (RR = 1.70; 95% CI = 1.2-2.4), and for leukemia (RR = 3.28; 95% CI = 1.0=10.6). Radiation combined with surgery, or given to treat gastric ulcer, appeared to increase the risk of stomach cancer 10-fold, which was greater than the sum of individual effects. Patients with gastric ulcers were at higher risk for stomach cancer than patients with duodenal ulcers. Conclusions: Patients with peptic ulcer are at increased risk of dying of cancer, related in part to lifestyle factors and treatment. Radiotherapy and surgery together appear to induce carcinogenic processes that greatly enhance the development of stomach cancer. The risk of radiation-induced stomach cancer was 0.25 extra deaths per 10 000 persons per year per Gy, somewhat lower than reported in other studies. High-dose radiation may have increased the risk of pancreatic cancer, a condition rarely found elevated in irradiated populations, but misclassified death notices may have contributed to the excess. Cancer mortality remained high for up to 50 years, indicating that radiation damage may persist to the end of life. [J Natl Cancer Inst 86: 842-849, 1994]

LanguageEnglish (US)
Pages842-849
Number of pages8
JournalJournal of the National Cancer Institute
Volume86
Issue number11
DOIs
StatePublished - Jun 1 1994

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Peptic Ulcer
Radiotherapy
Neoplasms
Stomach Neoplasms
Radiation
Confidence Intervals
Stomach Ulcer
Pancreatic Neoplasms
Radiation-Induced Neoplasms
Digestive System Diseases
Lung
Mortality
Gastric Acid
Duodenal Ulcer
Population
Life Style
Prostate
Pancreas
Heart Diseases
Leukemia

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Griem, M. L., Kleinerman, R. A., Boice, J. D., Stovall, M., Shefner, D., & Lubin, J. H. (1994). Cancer following radiotherapy for peptic ulcer. Journal of the National Cancer Institute, 86(11), 842-849. https://doi.org/10.1093/jnci/86.11.842

Cancer following radiotherapy for peptic ulcer. / Griem, Melvin L.; Kleinerman, Ruth A.; Boice, John D.; Stovall, Marilyn; Shefner, Deborah; Lubin, Jay H.

In: Journal of the National Cancer Institute, Vol. 86, No. 11, 01.06.1994, p. 842-849.

Research output: Contribution to journalArticle

Griem, ML, Kleinerman, RA, Boice, JD, Stovall, M, Shefner, D & Lubin, JH 1994, 'Cancer following radiotherapy for peptic ulcer', Journal of the National Cancer Institute, vol. 86, no. 11, pp. 842-849. https://doi.org/10.1093/jnci/86.11.842
Griem ML, Kleinerman RA, Boice JD, Stovall M, Shefner D, Lubin JH. Cancer following radiotherapy for peptic ulcer. Journal of the National Cancer Institute. 1994 Jun 1;86(11):842-849. https://doi.org/10.1093/jnci/86.11.842
Griem, Melvin L. ; Kleinerman, Ruth A. ; Boice, John D. ; Stovall, Marilyn ; Shefner, Deborah ; Lubin, Jay H. / Cancer following radiotherapy for peptic ulcer. In: Journal of the National Cancer Institute. 1994 ; Vol. 86, No. 11. pp. 842-849.
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abstract = "Background: Radiotherapy for peptic ulcer was used between 1937 and 1965 to control excessive gastric acid secretions (mean dose, 14.8 Gy). Patients with this benign condition live many years after treatment and are at risk for late effects. Purpose: Our purpose was to investigate the risk of death from cancer following radiotherapy for peptic ulcer. Methods: A mortality study was conducted of 3609 patients with peptic ulcer; 1831 were treated with radiation and 1778 were treated by other means. Extensive methods were used to trace patients. Radiation doses to specific organs were reconstructed from the original radiotherapy records. Results: Nearly 70{\%} of patients were found to have died. The average period of observation was 21.5 years (maximum 51 years). Compared with the general population, patients treated with or without radiation were at significantly increased risk of dying of cancer and non-malignant diseases of the digestive system. Risk of death due to heart disease was slightly higher following radiotherapy. Cancers of the stomach, pancreas, lung, and prostate were increased in both irradiated and nonirradiated patients. Radiotherapy was linked to significantly high relative risks (RRs) for all cancers combined (RR = 1.53; 95{\%} confidence interval [CI] = 13-1.8), for cancers of the stomach (RR = 2.77; 95{\%} CI = 1.6-4.8), pancreas (RR = 1.87; 95{\%} CI = 1.0-3.4), and lung (RR = 1.70; 95{\%} CI = 1.2-2.4), and for leukemia (RR = 3.28; 95{\%} CI = 1.0=10.6). Radiation combined with surgery, or given to treat gastric ulcer, appeared to increase the risk of stomach cancer 10-fold, which was greater than the sum of individual effects. Patients with gastric ulcers were at higher risk for stomach cancer than patients with duodenal ulcers. Conclusions: Patients with peptic ulcer are at increased risk of dying of cancer, related in part to lifestyle factors and treatment. Radiotherapy and surgery together appear to induce carcinogenic processes that greatly enhance the development of stomach cancer. The risk of radiation-induced stomach cancer was 0.25 extra deaths per 10 000 persons per year per Gy, somewhat lower than reported in other studies. High-dose radiation may have increased the risk of pancreatic cancer, a condition rarely found elevated in irradiated populations, but misclassified death notices may have contributed to the excess. Cancer mortality remained high for up to 50 years, indicating that radiation damage may persist to the end of life. [J Natl Cancer Inst 86: 842-849, 1994]",
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AU - Kleinerman, Ruth A.

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AU - Lubin, Jay H.

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N2 - Background: Radiotherapy for peptic ulcer was used between 1937 and 1965 to control excessive gastric acid secretions (mean dose, 14.8 Gy). Patients with this benign condition live many years after treatment and are at risk for late effects. Purpose: Our purpose was to investigate the risk of death from cancer following radiotherapy for peptic ulcer. Methods: A mortality study was conducted of 3609 patients with peptic ulcer; 1831 were treated with radiation and 1778 were treated by other means. Extensive methods were used to trace patients. Radiation doses to specific organs were reconstructed from the original radiotherapy records. Results: Nearly 70% of patients were found to have died. The average period of observation was 21.5 years (maximum 51 years). Compared with the general population, patients treated with or without radiation were at significantly increased risk of dying of cancer and non-malignant diseases of the digestive system. Risk of death due to heart disease was slightly higher following radiotherapy. Cancers of the stomach, pancreas, lung, and prostate were increased in both irradiated and nonirradiated patients. Radiotherapy was linked to significantly high relative risks (RRs) for all cancers combined (RR = 1.53; 95% confidence interval [CI] = 13-1.8), for cancers of the stomach (RR = 2.77; 95% CI = 1.6-4.8), pancreas (RR = 1.87; 95% CI = 1.0-3.4), and lung (RR = 1.70; 95% CI = 1.2-2.4), and for leukemia (RR = 3.28; 95% CI = 1.0=10.6). Radiation combined with surgery, or given to treat gastric ulcer, appeared to increase the risk of stomach cancer 10-fold, which was greater than the sum of individual effects. Patients with gastric ulcers were at higher risk for stomach cancer than patients with duodenal ulcers. Conclusions: Patients with peptic ulcer are at increased risk of dying of cancer, related in part to lifestyle factors and treatment. Radiotherapy and surgery together appear to induce carcinogenic processes that greatly enhance the development of stomach cancer. The risk of radiation-induced stomach cancer was 0.25 extra deaths per 10 000 persons per year per Gy, somewhat lower than reported in other studies. High-dose radiation may have increased the risk of pancreatic cancer, a condition rarely found elevated in irradiated populations, but misclassified death notices may have contributed to the excess. Cancer mortality remained high for up to 50 years, indicating that radiation damage may persist to the end of life. [J Natl Cancer Inst 86: 842-849, 1994]

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