The PESTO study focused on radiation dose response for second primary cancers of the stomach, esophagus, and pancreas: a study of cancer survivors. Numerous studies have identified the bone marrow, thyroid gland and female premenopausal breast as the tissues most susceptible to ionization radiation in the human body. Less is known about the susceptibility of the organs of the gastrointestinal tract.
In 2003, the National Cancer Institute coordinated this study on radiation induced oesophagus, stomach and pancreas cancer. Patients with an initial breast-, testis-, cervix cancer and malignant lymphoma and subsequent oesophagus, stomach and pancreas cancer were selected and cohorts created. In a second phase, nested case-control studies are conducted. Cases consisting of individuals with one of the first primary cancers and a subsequent oesophagus, stomach or pancreas cancer. Controls being those with only diagnosed with any of the first cancers.
Detailed information on tumour characteristics and therapy has been gathered from the case records and the abstraction was finalized during the spring of 2007. In parallel, tissue has been collected from first and second cancers. Polymorphisms in mainly DNA repaired genes will be analyzed and related to risk of a second cancer.
A number of studies focusing on radiation-induced stomach, oesophagus and pancreas cancer have been completed. All of them were nested case-control studies and different groups have taken responsibility for different outcomes. A number of papers have been published as listed below.
Project leader for the Swedish part: Per Hall
Project period: 2002-2015
Main financing: National Cancer Institute (NCI)
Ruth Kleinerman, Dr., Radiation and Epidemiology Branch, National Cancer Institute, USA
Lindsay Morton, Dr., Radiation and Epidemiology Branch, National Cancer Institute, USA
Second cancers among 40,576 testicular cancer patients: focus on long-term survivors.
Travis LB, Fosså SD, Schonfeld SJ, McMaster ML, Lynch CF, Storm H, et al
J. Natl. Cancer Inst. 2005 Sep;97(18):1354-65
Acute myeloid leukemia following Hodgkin lymphoma: a population-based study of 35,511 patients.
Schonfeld SJ, Gilbert ES, Dores GM, Lynch CF, Hodgson DC, Hall P, et al
J. Natl. Cancer Inst. 2006 Feb;98(3):215-8
Suicide after breast cancer: an international population-based study of 723,810 women.
Schairer C, Brown LM, Chen BE, Howard R, Lynch CF, Hall P, et al
J. Natl. Cancer Inst. 2006 Oct;98(19):1416-9
Leukemia following breast cancer: an international population-based study of 376,825 women.
Howard RA, Gilbert ES, Chen BE, Hall P, Storm H, Pukkala E, et al
Breast Cancer Res. Treat. 2007 Nov;105(3):359-68
Risk of second non-hematological malignancies among 376,825 breast cancer survivors.
Brown LM, Chen BE, Pfeiffer RM, Schairer C, Hall P, Storm H, et al
Breast Cancer Res. Treat. 2007 Dec;106(3):439-51
Noncancer causes of death in survivors of testicular cancer.
Fosså SD, Gilbert E, Dores GM, Chen J, McGlynn KA, Schonfeld S, et al
J. Natl. Cancer Inst. 2007 Apr;99(7):533-44
Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma.
Hodgson DC, Gilbert ES, Dores GM, Schonfeld SJ, Lynch CF, Storm H, et al
J. Clin. Oncol. 2007 Apr;25(12):1489-97
Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk.
Chaturvedi AK, Engels EA, Gilbert ES, Chen BE, Storm H, Lynch CF, et al
J. Natl. Cancer Inst. 2007 Nov;99(21):1634-43
Second cancers after squamous cell carcinoma and adenocarcinoma of the cervix.
Chaturvedi AK, Kleinerman RA, Hildesheim A, Gilbert ES, Storm H, Lynch CF, et al
J. Clin. Oncol. 2009 Feb;27(6):967-73
Risk of treatment-related esophageal cancer among breast cancer survivors.
Morton LM, Gilbert ES, Hall P, Andersson M, Joensuu H, Vaalavirta L, et al
Ann. Oncol. 2012 Dec;23(12):3081-91
Radiation dose and subsequent risk for stomach cancer in long-term survivors of cervical cancer.
Kleinerman RA, Smith SA, Holowaty E, Hall P, Pukkala E, Vaalavirta L, et al
Int. J. Radiat. Oncol. Biol. Phys. 2013 Aug;86(5):922-9
Stomach cancer risk after treatment for hodgkin lymphoma.
Morton LM, Dores GM, Curtis RE, Lynch CF, Stovall M, Hall P, et al
J. Clin. Oncol. 2013 Sep;31(27):3369-77