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Burns K, Phillips C, Brannigan R, Franklin A, Howell J, Schmidt D, Sopfe J, Appiah LC, Anazodo A. Male pediatric, adolescent, and young adult reproductive survivorship. Pediatr Blood Cancer 2023; 70 Suppl 5:e28823. [PMID: 37381156 DOI: 10.1002/pbc.28823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 06/30/2023]
Abstract
As pediatric, adolescent, and young adult cancer survival rates increase, emphasis is placed on reducing late effects, including reproductive complications and potential impact to fertility. Male survivors are at risk of abnormalities in sperm, hormone deficiencies, and sexual dysfunction. This can impact one's progression into puberty and ability to have a biological child and impacts quality of life following treatment. Access to reproductive care is important and requires patient assessment and appropriate referral to reproductive specialists. This review addresses reproductive complications associated with therapy, standard-of-care testing, and therapeutic interventions. The psychologic impact on psychosexual functioning is also addressed.
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Affiliation(s)
- Karen Burns
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine Phillips
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Brannigan
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Anna Franklin
- Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Howell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Deb Schmidt
- Division of Oncology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Jenna Sopfe
- Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Leslie Coker Appiah
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado
- Department of Surgery, Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Denver, Colorado
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- Nelune Comprehensive Cancer Centre, Randwick, New South Wales, Australia
- School of Women's and Children's, University of New South Wales, Sydney, New South Wales, Australia
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Fosså SD, Dahl AA, Thorsen L, Hellesnes R, Kiserud CE, Tandstad T, Brydøy M, Haugnes HS, Myklebust TÅ. Mortality and Second Cancer Incidence After Treatment for Testicular Cancer: Psychosocial Health and Lifestyle Are Modifiable Prognostic Factors. J Clin Oncol 2022; 40:2588-2599. [PMID: 35380874 DOI: 10.1200/jco.21.02105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) represent prognostic factors of overall mortality, cancer mortality, and first-time non-germ cell second cancer (SecCa) incidence. PATIENTS AND METHODS In 775 long-term TCSs (diagnosis: 1980-1994) who previously participated in a quality-of-life survey, 20-year mortality and SecCa incidence were compared between the surgery group (n = 272) and TCSs after platinum-based chemotherapy (PBCT; n = 503). A PBCT standard group (total cisplatin: ≤ 630 mg: n = 124) was separated from a PBCT high subgroup (total cisplatin: > 630 mg; n = 379). Univariate and multivariate analyses (Kaplan-Meier; Cox proportional hazard analyses) included age, treatment, and prior major physical comorbidity as nonmodifiable factors, whereas low socioeconomic status, unhealthy lifestyle, probable depression disorder, and neurotoxicity were modifiable AHOs. RESULTS For all TCSs, the cumulative overall 20-year mortality was 14% (95% CI, 11.8 to 16.8). Rising age, PBCT high, and comorbidity significantly increased the risk of overall mortality rate. Compared with a low-risk group (no AHO; n = 446) and with exception of neurotoxicity, this risk was further significantly enhanced by 80% in TCSs of a medium-risk group (one or two AHOs; n = 278). In men of a high-risk group (three AHOs; n = 47), the probability of overall mortality and of cancer mortality was eight-fold and five-fold increased, respectively. Risk grouping did not influence on SecCa incidence. CONCLUSION Self-reported unfavorable modifiable AHO concerning lifestyle and psychosocial health are in TCSs independently and significantly associated with increased overall mortality and cancer mortality. Health professionals and the TCSs themselves, particularly those after PBCT high, should continuously be aware of these risk factors attempting maximal reduction of these AHOs and thereby supporting long-term survival.
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Affiliation(s)
- Sophie D Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alv A Dahl
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Lene Thorsen
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Hellesnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | | | - Torgrim Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Brydøy
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University, Tromsø, Norway
| | - Tor Å Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Registration, Cancer Registry of Norway, Oslo, Norway
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Buck DA, Smith TD, Montana WN. An Uncommon Presentation of a Metachronous Testicular Primary Nonseminoma and Seminoma Separated by Two Decades and a Testicular Cancer Literature Review. Case Rep Oncol 2017; 10:832-839. [PMID: 29070998 PMCID: PMC5649222 DOI: 10.1159/000478846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Testicular cancer is the most common malignancy in men aged 15–40 years [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Its incidence comprises 0.8% of all male cancers worldwide, with a mortality rate of 0.1%. The incidence has nearly doubled from 1975 to 2007 leading to the concern of environmental causes [Thomas: Am J Epidemiol 2013; 178: 1240–1245]. Testicular cancer presents as a painless testicular mass without transillumination. Testicular cancer is subcategorized under germ cell testicular cancer or sex cord-stromal tumors. Of the germ cell tumors, approximately 90% originate in the testis, with the other 10% being extragonadal [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Typically, if a patient presents with a testicular mass and is 50 years old or older, the diagnosis of a primary lymphoma is considered until proven otherwise [Bols et al.: Philadelphia, Wolters Kluwer, Lippincott Williams & Wilkins, 2011]. Germ cell testicular cancer is further divided into the subtypes of seminomatous and nonseminomatous; each presents with a unique histology and differing treatment implications. Discussion Given the uniqueness of our patient's metachronous second testicular primary, we sought to compare our case findings to available historic publications. We sought to address the issues of the incidence of a second primary testicular malignancy with regard to varying histology, age of incidence, and timing of a second primary testicular cancer, the presence of bowel involvement, and finally a brief discussion of testosterone replacement therapy. Conclusion A review of our case presents several unique factors. The above varying literature has shown our patient to have met the odds of a contralateral testicular primary development in that he had a nonseminomatous primary, followed by a second testicular primary seminoma. Our patient exceeded the 15-year cumulative risk of contralateral metachronous testicular cancer of 1.9% versus the seemingly contradictory 5.2% cumulative risk 25 years after the first testicular germ cell tumor. With his second primary (seminoma), he presented with the common retroperitoneal landing zone site, though with an uncommon involvement of the gastrointestinal tract (<1%) and rare incidence of involving the duodenum.
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Affiliation(s)
- Dennis Andrew Buck
- Cancer Treatment Centers of America, Southwestern Regional Center, Tulsa, OK, USA
| | - Tristan Dean Smith
- Oklahoma State University, College of Osteopathic Medicine, Tulsa, OK, USA
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Herradón E, González C, Uranga JA, Abalo R, Martín MI, López-Miranda V. Characterization of Cardiovascular Alterations Induced by Different Chronic Cisplatin Treatments. Front Pharmacol 2017; 8:196. [PMID: 28533750 PMCID: PMC5420557 DOI: 10.3389/fphar.2017.00196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/24/2017] [Indexed: 01/17/2023] Open
Abstract
In the last years, many clinical studies have revealed that some cisplatin-treated cancer survivors have a significantly increased risk of cardiovascular events, being cisplatin-induced cardiovascular toxicity an increasing concern. The aim of the present work was to evaluate the cardiovascular alterations induced by different chronic cisplatin treatments, and to identify some of the mechanisms involved. Direct blood pressure, basal cardiac (left ventricle and coronary arteries) and vascular (aortic and mesenteric) functions were evaluated in chronic (5 weeks) saline- or cisplatin-treated male Wistar rats. Three different doses of cisplatin were tested (1, 2, and 3 mg/kg/week). Alterations in cardiac and vascular tissues were also investigated by immunohistochemistry, Western Blot, and or quantitative RT-PCR analysis. Cisplatin treatment provoked a significant modification of arterial blood pressure, heart rate, and basal cardiac function at the maximum dose tested. However, vascular endothelial dysfunction occurred at lower doses. The expression of collagen fibers and conexin-43 were increased in cardiac tissue in cisplatin-treated rats with doses of 2 and 3 mg/kg/week. The expression of endothelial nitric oxide synthase was also modified in cardiac and vascular tissues after cisplatin treatment. In conclusion, chronic cisplatin treatment provokes cardiac and vascular toxicity in a dose-dependent manner. Besides, vascular endothelial dysfunction occurs at lower doses than cardiac and systemic cardiovascular toxicity. Moreover, some structural changes in cardiac and vascular tissues are also patent even before any systemic cardiovascular alterations.
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Affiliation(s)
- Esperanza Herradón
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Cristina González
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - José A Uranga
- Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain.,Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain
| | - Raquel Abalo
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Ma I Martín
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Visitacion López-Miranda
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
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The experience of patients with early-stage testicular cancer during the transition from active treatment to follow-up surveillance. Urol Oncol 2015; 34:168.e11-20. [PMID: 26707612 DOI: 10.1016/j.urolonc.2015.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/21/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To gain a better understanding of the experiences of patients with early-stage testicular cancer during the transition from active cancer treatment to follow-up care. MATERIALS AND METHODS Cross-sectional multimethod study (questionnaires, focus groups, and telephone interviews) to describe experiences of patients with testicular cancer transitioning to survivorship. Questionnaire package included standardized measures of survivorship knowledge, feeling of preparedness, health-related distress, and perspectives on care coordination. Standard descriptive statistics and Mann-Whitney tests to examine associations between all outcomes based on demographic and clinical variables were performed. Qualitative results (focus groups and interviews) were analyzed with qualitative content analysis. RESULTS Based on quantitative data (n = 90) and qualitative analyses (n = 13), participants had relatively high survivorship knowledge, most testicular cancer survivors were not provided with any formal transition planning or documentation, and a substantial minority felt unprepared to cope with the aftereffects of testicular cancer and the posttreatment survivorship phase. Younger men had lower survivorship knowledge, feelings of preparedness, and continuity of care scores and were less likely to report having received any self-management tools and education or information of patient resources. Participants reported that they did not know what to expect physically or emotionally after treatment ended and many continued to be frustrated and worried about their health problems. They expressed the need for reliable and personalized resources on what to expect after treatment and more formal transition care planning. CONCLUSIONS Patients with testicular cancer continue to struggle in their transition to posttreatment survivorship. Quality of care must emphasize a shift from a purely disease-focused approach to a wellness-centered approach that provides coordinated, patient-centered, and comprehensive care to optimize quality of life for these survivors.
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Baker KS, Chow EJ, Goodman PJ, Leisenring WM, Dietz AC, Perkins JL, Chow L, Sinaiko A, Moran A, Petryk A, Steinberger J. Impact of treatment exposures on cardiovascular risk and insulin resistance in childhood cancer survivors. Cancer Epidemiol Biomarkers Prev 2013; 22:1954-63. [PMID: 24008489 DOI: 10.1158/1055-9965.epi-13-0610] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) are more insulin resistant and have higher levels of several cardiovascular risk factors even while still children. This study examines specific treatment exposures associated with cardiovascular risk factors and insulin resistance. METHODS CCS of ages 9 to 18 years at study entry and in remission 5 years or more from diagnosis (n = 319) and 208 sibling controls were recruited into this cross-sectional study that included physiologic assessment of insulin resistance (hyperinsulinemic euglycemic clamp) and assessment of cardiovascular risk factors. Regression and recursive tree modeling were used to ascertain treatment combinations associated with insulin resistance and cardiovascular risk. RESULTS Mean current age of CCS was 14.5 years and 54% were male (siblings 13.6 years, 54% male). Diagnoses included leukemia (35%), brain tumors (36%), solid tumors (33%), or lymphoma (6%). Among CCS, analysis of individual chemotherapy agents failed to find associations with cardiovascular risk factors or insulin resistance. Compared with siblings, insulin resistance was significantly higher in CCS who received platinum plus cranial radiotherapy (CRT, 92% brain tumors) and in those who received steroids but no platinum (majority leukemia). Insulin resistance did not differ between CCS who received surgery alone versus siblings. Within survivor comparisons failed to elucidate treatment combinations that increased insulin resistance compared with those who received surgery only. CONCLUSIONS Exposure to platinum, CRT, or steroids is associated with insulin resistance and cardiovascular risk factors and should be taken into consideration in the development of screening recommendations for cardiovascular risk. IMPACT Earlier identification of CCS who may benefit from targeted prevention efforts may reduce their future risk of cardiovascular disease.
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Affiliation(s)
- K Scott Baker
- Authors' Affiliations: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of California San Diego & Rady Children's Hospital, San Diego, California; Children's Hospitals and Clinics of Minnesota; and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Abstract
OBJECTIVES To discuss the presentation, diagnosis, chemotherapy, surgical options, nursing management, and long-term outcomes of patients with testicular cancer. DATA SOURCES Review and research articles, clinical experience. CONCLUSION Testicular cancer is very treatable and the cure rate is approximately 95%. It is most common in men between the ages of 15 and 35. While early detection, diagnosis, and treatment are all important factors for treating the disease, fertility and quality of life are also important issues to address in patients with testicular cancer. IMPLICATION FOR NURSING PRACTICE Nurses must provide patient instruction regarding chemotherapy, surgery, fertility, and side effects of treatment. Serving as a patient advocate regarding fertility preservation and promoting quality of life are important factors for health professionals to consider.
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Bender JL, Wiljer D, To MJ, Bedard PL, Chung P, Jewett MAS, Matthew A, Moore M, Warde P, Gospodarowicz M. Testicular cancer survivors' supportive care needs and use of online support: a cross-sectional survey. Support Care Cancer 2012; 20:2737-46. [PMID: 22382589 DOI: 10.1007/s00520-012-1395-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jacqueline L Bender
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada
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Sexual Health During Cancer Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:61-76. [DOI: 10.1007/978-94-007-2492-1_5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abouassaly R, Fossa SD, Giwercman A, Kollmannsberger C, Motzer RJ, Schmoll HJ, Sternberg CN. Sequelae of treatment in long-term survivors of testis cancer. Eur Urol 2011; 60:516-26. [PMID: 21684072 DOI: 10.1016/j.eururo.2011.05.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/30/2011] [Indexed: 11/25/2022]
Abstract
CONTEXT Testicular cancer patients are often diagnosed at a young age, and because of the advances in the treatment of this disease, the vast majority have a normal life expectancy after therapy. Thus, recognition of the long-term sequelae of treatment (ie, surgery, radiation therapy, and chemotherapy) is particularly important in these patients. OBJECTIVE To review the adverse effects and the risk of secondary malignancy in long-term survivors of testicular cancer. EVIDENCE ACQUISITION We conducted a Medline search to identify original articles and reviews on the long-term effects of testicular cancer treatment. Although the search included articles from January 1948 to February 2011, the majority of the included articles were published in the last two decades. EVIDENCE SYNTHESIS All studies examining the long-term sequelae of treatment in testicular cancer are retrospective in nature, with most classified as cohort, case-control, and/or epidemiologic studies. Given that no standardized method of reporting long-term complications exists, evidence synthesis is limited. CONCLUSIONS Recent evidence suggests an increased risk of cardiovascular disease, neurotoxicity, and mild reductions in renal function in survivors of testicular cancer. Treatment of testicular malignancy can also negatively affect gonadal function and fertility and has been shown to result in an increased risk of solid malignancy and leukemia.
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Affiliation(s)
- Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
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Marconato L, Stefanello D, Valenti P, Bonfanti U, Comazzi S, Roccabianca P, Caniatti M, Romanelli G, Massari F, Zini E. Predictors of long-term survival in dogs with high-grade multicentric lymphoma. J Am Vet Med Assoc 2011; 238:480-5. [DOI: 10.2460/javma.238.4.480] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Travis LB, Beard C, Allan JM, Dahl AA, Feldman DR, Oldenburg J, Daugaard G, Kelly JL, Dolan ME, Hannigan R, Constine LS, Oeffinger KC, Okunieff P, Armstrong G, Wiljer D, Miller RC, Gietema JA, van Leeuwen FE, Williams JP, Nichols CR, Einhorn LH, Fossa SD. Testicular cancer survivorship: research strategies and recommendations. J Natl Cancer Inst 2010; 102:1114-30. [PMID: 20585105 DOI: 10.1093/jnci/djq216] [Citation(s) in RCA: 230] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Testicular cancer represents the most curable solid tumor, with a 10-year survival rate of more than 95%. Given the young average age at diagnosis, it is estimated that effective treatment approaches, in particular, platinum-based chemotherapy, have resulted in an average gain of several decades of life. This success, however, is offset by the emergence of considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, decreased fertility, and psychosocial problems. Data on underlying genetic or molecular factors that might identify those patients at highest risk for late sequelae are sparse. Genome-wide association studies and other translational molecular approaches now provide opportunities to identify testicular cancer survivors at greatest risk for therapy-related complications to develop evidence-based long-term follow-up guidelines and interventional strategies. We review research priorities identified during an international workshop devoted to testicular cancer survivors. Recommendations include 1) institution of lifelong follow-up of testicular cancer survivors within a large cohort setting to ascertain risks of emerging toxicities and the evolution of known late sequelae, 2) development of comprehensive risk prediction models that include treatment factors and genetic modifiers of late sequelae, 3) elucidation of the effect(s) of decades-long exposure to low serum levels of platinum, 4) assessment of the overall burden of medical and psychosocial morbidity, and 5) the eventual formulation of evidence-based long-term follow-up guidelines and interventions. Just as testicular cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of testicular cancer survivors can pioneer new methodologies in survivorship research for all adult-onset cancer.
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Affiliation(s)
- Lois B Travis
- Department of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Morash C, Cagiannos I. High-risk clinical stage I NSGCT: the case for RPLND. World J Urol 2009; 27:449-53. [PMID: 19488758 DOI: 10.1007/s00345-009-0425-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 05/12/2009] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION High-risk clinical stage I NSGCT patients are at significant risk of harbouring occult metastatic disease. In these patients, treatment options consist of retroperitoneal lymph node dissection (RPLND) or two cycles of primary BEP chemotherapy. Both these options provide a nearly 100% cure rate. MATERIALS AND METHODS We review the rationale for both treatments. CONCLUSIONS Advantages of RPLND include high cure rate with single modality therapy eliminating the need for chemotherapy with its attendant long-term toxicities in the majority of patients.
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Affiliation(s)
- Christopher Morash
- Division of Urology, Department of Surgery, B3 Urology, The Ottawa Hospital, Ottawa, ON, K1Y 4E9, Canada.
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Abstract
Cancer survivorship is an emerging area of scientific and clinical interest. Several decades ago, most people diagnosed with cancer did not live long beyond their initial diagnosis. Today the number of cancer survivors exceeds ten million, and this group may experience unique healthcare issues related to their cancer treatment. Chemotherapy, surgery, and radiation therapy each have their own late and long-term complications. It is imperative for clinicians who are caring for cancer survivors to be aware of long-term complications of therapy and to treat these appropriately. When cancer therapy has successfully added years of life, it is equally as important that medical care assures the best quality of life during those years.
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Affiliation(s)
- Kenneth D Miller
- Department of Medical Oncology Yale Cancer Center, New Haven, CT, USA.
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