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 HorenblasFlora E. van Leeuwen, Michael Schaapveld

Research output: Contribution to journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)901-907
Number of pages7
JournalBritish Journal of Cancer
Issue number7
Publication statusPublished - 2018

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