Risk of diabetes after para-aortic radiation for testicular cancer
Menée aux Pays-Bas à partir de données portant sur 2 998 patients ayant survécu un an à un cancer du testicule traité avant l'âge de 50 ans par orchidectomie avec ou sans radiothérapie avec irradiation des ganglions para-aortiques entre 1976 et 2007, cette étude analyse le risque de diabète en lien avec la dose de rayonnements reçus (durée médiane de suivi : 13,4 ans ; 161 cas de diabète)
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.