Second Malignancies following Pure Seminoma

Abstract

Purpose: Second malignancies in patients with pure testicular seminoma were studied in order to look for adverse late effects of treatment and to study the significance of second malignancies during follow-up. Patients, Methods: In a multicentric investigation, 839 consecutive patients with pure testicular seminoma were observed for a median follow-up of 3.9 years. Thirty-seven patients had been excluded from the study because they already had had either a contralateral testicular germ cell tumor or another malignancy. 758 patients received radiotherapy, 76 underwent chemotherapy, 5 had surveillance only. The expected rate of second cancers was calculated according to the data of the cancer registry of Saarland, Germany. Results: Twenty-two second cancers (13 contralateral testicular tumors, 9 extratesticular malignancies) were recorded. The overall risk of having a second cancer was RR = 4.8 (95% CI 3.0–7.3). The risk of having a subsequent testicular tumor is RR = 44.8 (95% Cl 23.9–76.7). 1.1% of the patients developed a nontesticular second tumor. The risk of having a nontesticular second cancer is RR = 2.1 (95% CI 1.0–4.0). A significantly increased risk was observed for renal cell cancer as well (RR = 12.5; 95% Cl: 1.5–45.1). Increased RR without reaching statistical significance were found for rectal cancer (RR = 5.0; 95% Cl: 0.1–27.9) and non-Hodgkin lymphoma (RR = 6.7; 95% CI 0.2–37.1). None of the second cancers were directly located within the radiation field; 5 neoplasms arose at the border of the radiation field. Conclusions: This study confirmed the increased risk of having a second testicular germ cell cancer. There is also a small but definitely increased overall risk of having a nontesticular second cancer. Treatment-unrelated factors – possibly genetic predisposition – must be considered for a substantial number of these second tumors, since in the present study the follow-up was rather short and most of the second cancers were located outside of the radiation fields. In particular, the association of renal cancer with testicular cancer appears to be a more than chance occurrence. Second cancer is a real hazard following treatment of testicular cancers and should always be considered during follow-up.

Diffuse pigmented villonodular synovitis of the foot and ankle treated with surgery and radiotherapy

“…These studies, whilst instructive for specific populations, should not necessarily be used to estimate risk for patients without malignant disease. This is highlighted by the fact that some of these tumours occur with increasing frequency at nonirradiated sites and are therefore due to factors unrelated to treatment-possibly genetic pre-disposition [10]. After treatment for benign disease such as Grave's ophthalmopathy in young patients, an absolute lifetime risk of radiation-induced cancer has been estimated at 0.3% [3].…”

Treatment-related ureteral cancer following stage II testicular seminoma

“…2 Reports of ureteral cancer in patients with testicular seminoma are rare. 9 However, some investigators have reported elevated risks of cancer of the bladder and the kidney among such patients. 2,9 Travis et al 2 found that urothelial carcinoma of the renal pelvis (n = 20) accounted for approximately 33% of kidney cancers for which the histologic type was specifi ed (n = 61); this is more frequent than the incidence in the general population (approximately 10% of all renal tumors).…”

New Guidelines for Clinical Stage I Testicular Seminoma?

“…Rüther et al [7 ]observed an increased risk of second malignancy after seminoma therapy by irradiation to the PA and ipsilateral pelvic nodes at doses of 26–36 Gy. The risk of renal cell cancer was significantly increased, while that of rectal cancer and non-Hodgkin’s lymphoma was increased but not significantly different.…”

“…A cure is also achieved in nearly 100% of these patients by subsequent salvage chemotherapy. Contralateral germ cell tumors occur in 1.5% of the cases and are usually metachronous [7]. …”

“…This applies especially to stage I patients, who are advised to undergo radiotherapy to reduce their 20% risk of occult metastasis to 3–4% [6]. Nevertheless, this standard approach means overtreatment in 80% of the cases, and the higher risk of secondary malignancies developing inside and outside the radiation field is well known [7]. Moreover, several reports suggest a significantly increased incidence of late health problems, including a higher risk of cardiac disease secondary to radiotherapy [8].…”