Mortality after cure of XXXX .

@entity1 @entity5 @entity299 @entity4797 @entity204
PURPOSE: To determine the incidence of potentially treatment-related mortality in long-term survivors of @entity4797 treated by orchiectomy and radiation therapy (XRT). @entity1 AND METHODS: From all 477 @entity1 with stage I or II @entity4797 treated at The University of Texas M.D. Anderson @entity5 Center (Houston, TX) with post-orchiectomy megavoltage XRT between 1951 and 1999, 453 never sustained relapse of their disease. Long-term survival for these 453 @entity1 was evaluated with the @entity1 -years method to determine the standardized mortality ratio (SMR). SMRs were calculated for all causes of @entity204 , @entity204 , and @entity5 deaths using standard US data for males. RESULTS: After a median follow-up of 13.3 years, the 10-, 20-, 30-, and 40-year actuarial survival rates were 93%, 79%, 59%, and 26%, respectively. The all-cause SMR over the entire observation interval was 1.59 (99% CI, 1.21 to 2.04). The SMR was not excessive for the first 15 years of follow-up: SMR, 1.30 (95% CI, 0.93 to 1.77); but beyond 15 years the SMR was 1.85 (99% CI, 1.30 to 2.55). The overall cardiac-specific SMR was 1.61 (95% CI, 1.21 to 2.24). The cardiac SMR was significantly elevated only beyond 15 years (P <.01). The overall @entity5 -specific SMR was 1.91 (99% CI, 1.14 to 2.98). The @entity5 SMR was also significant only after 15 years of follow-up (P <.01). An increased mortality was evident in @entity1 treated with and without mediastinal XRT. CONCLUSION: Long-term survivors of @entity4797 treated with post-orchiectomy XRT are at significant excess risk of @entity204 as a result of @entity299 or second @entity5 . Management strategies that minimize these risks but maintain the excellent hitherto observed cure rates need to be actively pursued.
