Risk of diabetes after para-aortic radiation for testicular cancer

Abstract

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.

New onset of type 2 diabetes as a complication after cancer diagnosis: A systematic review

“…Two of these four studies found that, in the first year of follow‐up since diagnosis, the HRs of T2D development were highest for colorectal cancer patients, at 1.53, 16 and 1.47 (95% CI: 1.35–1.60) overall for patients with cancer 13 . Groot and colleagues reported the long‐term incidence rate of T2D at 20 and 30 years after testicular cancer treatment and found that the longer cancer survivors live, the higher the incidence of T2D 20 . Lipscombe and colleagues found the similar pattern that displays the increase in cumulative incidence over time in patients with breast cancer 15 …”

“…Multiple comorbidities, such as hypercholesterolemia, 20 hypertension, 14,16,20,25 cardiovascular disease, 14‐16,19,25,27 dyslipidemia, 14,27 dementia, liver disease, renal disease, rheumatologic disease, peptic ulcer disease, HIV/AIDS, 12,15,27 weight loss, 25 depression, 14 and chronic kidney disease, 12,14,15 at diagnosis were considered. Those with new onset of T2D were more likely to have at least one chronic disease 16 .…”

“…A complete list of cancer types is displayed in Table 1. Six studies used a population‐based database, 12‐17 while the remaining studies used individual hospital medical records 18‐27 . The age of the study population ranged from 20 to 105 years old.…”

“…This was followed by the HR of acute myeloid leukemia (AML) patients, 3.85 (95% CI: 3.35–4.42) 19 . Four studies evaluated T2D incidence at different time periods following diagnosis 13,15,16,20 . Two of these four studies found that, in the first year of follow‐up since diagnosis, the HRs of T2D development were highest for colorectal cancer patients, at 1.53, 16 and 1.47 (95% CI: 1.35–1.60) overall for patients with cancer 13 .…”

Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research

“…Jensen et al ( 58 ) also reported a 29% increased risk of diabetes in AYAs compared with the general population and found that diabetes was one of the leading reasons for hospital visits. Studies in specific AYA cancers have also reported increased diabetes risk among HL ( 63 ) and testicular cancer survivors treated with para-aortic RT ( 64 ). The pathogenesis of diabetes in these populations is largely related to pancreatic and adipose tissue toxicity from abdominal RT and chemotherapy, leading to changes in pancreatic function and insulin resistance ( 65-67 ).…”