Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer

Ruth A. Kleinerman, Susan A. Smith, Eric Holowaty, Per Hall, Eero Pukkala, Leila Vaalavirta, Marilyn Stovall, Rita Weathers, Ethel Gilbert, Berthe M.P. Aleman, Magnus Kaijser, Michael Andersson, Hans Storm, Heikki Joensuu, Charles F. Lynch, Graça M. Dores, Lois B. Travis, Lindsay M. Morton, Rochelle E. Curtis

Research output: Contribution to journalArticle

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Abstract

Purpose: To assess the dose-response relationship for stomach cancer after radiation therapy for cervical cancer. Methods and Materials: We conducted a nested, matched case-control study of 201 cases and 378 controls among 53,547 5-year survivors of cervical cancer diagnosed from 1943 to 1995, from 5 international, population-based cancer registries. We estimated individual radiation doses to the site of the stomach cancer for all cases and to corresponding sites for the matched controls (overall mean stomach tumor dose, 2.56 Gy, range 0.03-46.1 and after parallel opposed pelvic fields, 1.63 Gy, range 0.12-6.3). Results: More than 90% of women received radiation therapy, mostly with external beam therapy in combination with brachytherapy. Stomach cancer risk was nonsignificantly increased (odds ratio 1.27-2.28) for women receiving between 0.5 and 4.9 Gy to the stomach cancer site and significantly increased at doses ≥5 Gy (odds ratio 4.20, 95% confidence interval 1.41-13.4, Ptrend=.047) compared with nonirradiated women. A highly significant radiation dose-response relationship was evident when analyses were restricted to the 131 cases (251 controls) whose stomach cancer was located in the middle and lower portions of the stomach (Ptrend=.003), whereas there was no indication of increasing risk with increasing dose for 30 cases (57 controls) whose cancer was located in the upper stomach (Ptrend=.23). Conclusions: Our findings show for the first time a significant linear dose-response relationship for risk of stomach cancer in long-term survivors of cervical cancer.

Original languageEnglish (US)
Pages (from-to)922-929
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume86
Issue number5
DOIs
StatePublished - Aug 1 2013

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stomach
Uterine Cervical Neoplasms
Stomach Neoplasms
Survivors
cancer
Radiation
dosage
radiation
Stomach
Radiation Dose-Response Relationship
Case-Control Studies
Radiotherapy
Odds Ratio
Neoplasms
Brachytherapy
radiation therapy
Registries
Confidence Intervals
confidence
therapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Kleinerman, R. A., Smith, S. A., Holowaty, E., Hall, P., Pukkala, E., Vaalavirta, L., ... Curtis, R. E. (2013). Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer. International Journal of Radiation Oncology Biology Physics, 86(5), 922-929. https://doi.org/10.1016/j.ijrobp.2013.04.010

Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer. / Kleinerman, Ruth A.; Smith, Susan A.; Holowaty, Eric; Hall, Per; Pukkala, Eero; Vaalavirta, Leila; Stovall, Marilyn; Weathers, Rita; Gilbert, Ethel; Aleman, Berthe M.P.; Kaijser, Magnus; Andersson, Michael; Storm, Hans; Joensuu, Heikki; Lynch, Charles F.; Dores, Graça M.; Travis, Lois B.; Morton, Lindsay M.; Curtis, Rochelle E.

In: International Journal of Radiation Oncology Biology Physics, Vol. 86, No. 5, 01.08.2013, p. 922-929.

Research output: Contribution to journalArticle

Kleinerman, RA, Smith, SA, Holowaty, E, Hall, P, Pukkala, E, Vaalavirta, L, Stovall, M, Weathers, R, Gilbert, E, Aleman, BMP, Kaijser, M, Andersson, M, Storm, H, Joensuu, H, Lynch, CF, Dores, GM, Travis, LB, Morton, LM & Curtis, RE 2013, 'Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer', International Journal of Radiation Oncology Biology Physics, vol. 86, no. 5, pp. 922-929. https://doi.org/10.1016/j.ijrobp.2013.04.010
Kleinerman, Ruth A. ; Smith, Susan A. ; Holowaty, Eric ; Hall, Per ; Pukkala, Eero ; Vaalavirta, Leila ; Stovall, Marilyn ; Weathers, Rita ; Gilbert, Ethel ; Aleman, Berthe M.P. ; Kaijser, Magnus ; Andersson, Michael ; Storm, Hans ; Joensuu, Heikki ; Lynch, Charles F. ; Dores, Graça M. ; Travis, Lois B. ; Morton, Lindsay M. ; Curtis, Rochelle E. / Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 86, No. 5. pp. 922-929.
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AU - Kleinerman, Ruth A.

AU - Smith, Susan A.

AU - Holowaty, Eric

AU - Hall, Per

AU - Pukkala, Eero

AU - Vaalavirta, Leila

AU - Stovall, Marilyn

AU - Weathers, Rita

AU - Gilbert, Ethel

AU - Aleman, Berthe M.P.

AU - Kaijser, Magnus

AU - Andersson, Michael

AU - Storm, Hans

AU - Joensuu, Heikki

AU - Lynch, Charles F.

AU - Dores, Graça M.

AU - Travis, Lois B.

AU - Morton, Lindsay M.

AU - Curtis, Rochelle E.

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N2 - Purpose: To assess the dose-response relationship for stomach cancer after radiation therapy for cervical cancer. Methods and Materials: We conducted a nested, matched case-control study of 201 cases and 378 controls among 53,547 5-year survivors of cervical cancer diagnosed from 1943 to 1995, from 5 international, population-based cancer registries. We estimated individual radiation doses to the site of the stomach cancer for all cases and to corresponding sites for the matched controls (overall mean stomach tumor dose, 2.56 Gy, range 0.03-46.1 and after parallel opposed pelvic fields, 1.63 Gy, range 0.12-6.3). Results: More than 90% of women received radiation therapy, mostly with external beam therapy in combination with brachytherapy. Stomach cancer risk was nonsignificantly increased (odds ratio 1.27-2.28) for women receiving between 0.5 and 4.9 Gy to the stomach cancer site and significantly increased at doses ≥5 Gy (odds ratio 4.20, 95% confidence interval 1.41-13.4, Ptrend=.047) compared with nonirradiated women. A highly significant radiation dose-response relationship was evident when analyses were restricted to the 131 cases (251 controls) whose stomach cancer was located in the middle and lower portions of the stomach (Ptrend=.003), whereas there was no indication of increasing risk with increasing dose for 30 cases (57 controls) whose cancer was located in the upper stomach (Ptrend=.23). Conclusions: Our findings show for the first time a significant linear dose-response relationship for risk of stomach cancer in long-term survivors of cervical cancer.

AB - Purpose: To assess the dose-response relationship for stomach cancer after radiation therapy for cervical cancer. Methods and Materials: We conducted a nested, matched case-control study of 201 cases and 378 controls among 53,547 5-year survivors of cervical cancer diagnosed from 1943 to 1995, from 5 international, population-based cancer registries. We estimated individual radiation doses to the site of the stomach cancer for all cases and to corresponding sites for the matched controls (overall mean stomach tumor dose, 2.56 Gy, range 0.03-46.1 and after parallel opposed pelvic fields, 1.63 Gy, range 0.12-6.3). Results: More than 90% of women received radiation therapy, mostly with external beam therapy in combination with brachytherapy. Stomach cancer risk was nonsignificantly increased (odds ratio 1.27-2.28) for women receiving between 0.5 and 4.9 Gy to the stomach cancer site and significantly increased at doses ≥5 Gy (odds ratio 4.20, 95% confidence interval 1.41-13.4, Ptrend=.047) compared with nonirradiated women. A highly significant radiation dose-response relationship was evident when analyses were restricted to the 131 cases (251 controls) whose stomach cancer was located in the middle and lower portions of the stomach (Ptrend=.003), whereas there was no indication of increasing risk with increasing dose for 30 cases (57 controls) whose cancer was located in the upper stomach (Ptrend=.23). Conclusions: Our findings show for the first time a significant linear dose-response relationship for risk of stomach cancer in long-term survivors of cervical cancer.

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