An Evaluation Of Competing Causes Of Death in Patients Treated for Seminoma With Radiation Therapy.


      To review the long-term outcomes and evaluate the competing causes of death in patients treated with radiation therapy for Seminoma in British Columbia (BC).


      In total 538 patients diagnosed with Seminoma, and treated with radiation therapy (RT), between Jan 1990 and Jan 2010, were identified from the BC Cancer Registry. Median age was 38 years (range: 19 – 77). The median RT dose was 25 Gy (range: 14 Gy – 40 Gy). Most common RT fractionations used were: 25 Gy/15 (n = 260), 25 Gy/20 (n = 119), 30 Gy/20 (n = 90). Time to testicular-cancer mortality (TCM), second cancer related mortality (SCM), cardiovascular mortality (CVM), and all-cause mortality (ACM) were calculated from diagnosis date. Survival estimates were calculated using the Kaplan-Meier method. Competing-risks analysis was used to evaluate the Cumulative Incidence of the mortality outcomes.


      After a median follow-up of 18 years, 57 patients had died, and the 15-year Overall Survival was 90.8%. Thirteen patients died from progressive testicular cancer, 12 from Second Cancers, 13 from cardio-vascular disease, 7 from accidents and falls, 3 treatment related toxicity, and 9 from other causes. The cumulative rates of ACM at 10, 15, and 20 years were 5.8%, 9.2%, and 11.2%, respectively. All testicular cancer related mortality occurred within the first 6 years, and the 10 and 15 year rates of TCM were both 2.41%. Cardio-vascular and second cancer related mortality rates increased with time: 10yr CVM = 1.12%, 15yr CVM = 2.36%, 20yr CVM = 2.66%; 10yr SCM = 0.94%, 15yr SCM = 1.84%, and 20yr SCM = 2.53%.


      Long term outcomes for patients with Seminoma continue to be excellent, with an all-cause mortality rate of 11.2% at 20 years. After radiation therapy, the 20 year mortality rates from second cancers (2.53%) and cardiovascular disease (2.66%) are comparable to the testicular cancer related mortality (2.41%).


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