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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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2
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Wood GE, Chamberlain F, Tran B, Conduit C, Liow E, Nicol DL, Shamash J, Alifrangis C, Rajan P. Treatment de-escalation for stage II seminoma. Nat Rev Urol 2023:10.1038/s41585-023-00727-0. [PMID: 36882564 DOI: 10.1038/s41585-023-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
International Germ Cell Cancer Collaborative Group good-risk metastatic seminoma has cure rates of >95%. Within this risk group, patients with stage II disease exhibit the best oncological outcomes with the standard-of-care treatment strategies of radiotherapy or combination chemotherapy. However, these treatments can be associated with substantial early and late toxic effects. Therapy de-escalation aims to reduce treatment morbidity whilst preserving oncological outcomes. The evidence supporting such approaches is largely from non-randomized institutional data, and therefore this strategy is not recognized as standard of care. Current de-escalation approaches for stage II seminoma include single-agent chemotherapy, radiotherapy and surgery based on early data from clinical studies. Increased recognition of emerging data on treatment modification to reduce morbidity whilst maintaining cure rates and consideration of therapy de-escalation could improve patient survivorship outcomes.
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Affiliation(s)
- Georgina E Wood
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Elizabeth Liow
- Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - David L Nicol
- Department of Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Constantine Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK. .,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Department of Urology, Barts Health NHS Trust, London, UK. .,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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3
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Albersen M, Van den Broeck T. Stage II Seminoma: Is There Something New on the Horizon? EUR UROL SUPPL 2023; 49:78-79. [PMID: 36793749 PMCID: PMC9923177 DOI: 10.1016/j.euros.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - Thomas Van den Broeck
- Corresponding author. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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4
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Mahdi Seyedzadeh Sani S, Sahranavard M, Jannati Yazdanabad M, Seddigh Shamsi M, Elyasi S, Hooshang Mohammadpour A, Sathyapalan T, Arasteh O, Ghavami V, Sahebkar A. The effect of concomitant use of Colony-Stimulating factors on bleomycin pulmonary toxicity - A systematic review and meta-analysis. Int Immunopharmacol 2022; 112:109227. [PMID: 36099787 DOI: 10.1016/j.intimp.2022.109227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/06/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changes in the incidence of bleomycin pulmonary toxicity (BPT) as a result of adding colony-stimulating factors (CSF) to bleomycin regimens has been investigated in numerous studies. We performed a systematic review and meta-analysis to assess the outcomes of these studies. METHODS A systematic search was performed using Pubmed, Scopus, Web of Science, and Embase on April 2021. Studies evaluating the incidence of BPT in patients receiving bleomycin with and without CSF were included. In addition, meta-analysis was performed by pooling odds ratios using R. RESULTS Out of 340 obtained records, our qualitative and quantitative analysis included 3234 and 1956 patients from 22 and 14 studies, respectively. The quantitative synthesis showed that addition of CSF significantly increased the risk of BPT incidence (OR = 1.82, 95 % CI: 1.37-2.40, p < 0.0001; I2 = 10.7 %). Subgroup analysis did not show any association between continent, bleomycin dose, cancer type, type of study, and pulmonary function test with BPT incidence. CONCLUSION This systematic review and meta-analysis showed that co-administration of CSF with bleomycin increases the incidence of BPT. The physicians need to consider this finding while deciding the best strategy for this cohort of patients.
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Affiliation(s)
| | - Mehrdad Sahranavard
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Mahdi Jannati Yazdanabad
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Seddigh Shamsi
- Department of Hematology Oncology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Vahid Ghavami
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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5
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Stelwagen J, Meuleman AT, Lubberts S, Steursma G, Kruyt LM, Donkerbroek JW, Meijer C, Walenkamp AME, Lefrandt JD, Rakers SE, Huitema RB, de Jong MAA, Wiegman EM, van den Bergh ACM, de Jong IJ, van Rentergem JAA, Schagen SB, Nuver J, Gietema JA. Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment. Cancers (Basel) 2021; 13:5675. [PMID: 34830829 PMCID: PMC8616311 DOI: 10.3390/cancers13225675] [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: 10/30/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. METHODS In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)-with a follow-up duration ≥ 20 years-and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). RESULTS We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20-42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score -0.85; 95% CI -1.39 to -0.33) compared to controls (mean 0.67; 95% CI -0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β -1.50, p < 0.01), high c-PWV (β -0.35, p = 0.09), and high AGEs (β -1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β -1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01). CONCLUSIONS Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. TRIAL REGISTRATION NCT02572934.
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Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Andrea T. Meuleman
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Lara M. Kruyt
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jan W. Donkerbroek
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Annemiek M. E. Walenkamp
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Sandra E. Rakers
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Rients B. Huitema
- Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (S.E.R.); (R.B.H.)
| | - Marianne A. A. de Jong
- Department of Radiotherapy, Radiotherapeutic Institute Friesland, 8900 CC Leeuwarden, The Netherlands;
| | - Erwin M. Wiegman
- Department of Radiotherapy, Isala Hospital, 8025 AB Zwolle, The Netherlands;
| | - Alfons C. M. van den Bergh
- Department of Radiotherapy, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Igle J. de Jong
- Department of Urology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands;
| | - Joost A. Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Sanne B. Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands; (J.A.A.v.R.); (S.B.S.)
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands; (J.S.); (A.T.M.); (S.L.); (G.S.); (L.M.K.); (J.W.D.); (C.M.); (A.M.E.W.); (J.N.)
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Mittal A, Bhethanabhotla S, Ganguly S, Vishnubhatla S, Khadgawat R, Patel C, Mohan A, Biswas A, Bakhshi S. Late effects in pediatric Hodgkin lymphoma survivors after uniform treatment with ABVD with or without radiotherapy. Pediatr Blood Cancer 2021; 68:e29293. [PMID: 34431211 DOI: 10.1002/pbc.29293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/13/2021] [Accepted: 07/31/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE ABVD (doxorubicin, bleomycin,vinblastine, and dacarbazine) is not a standard regimen in children due to concerns regarding late effects. However, no studies have evaluated long-term toxicities of ABVD in children. METHODS Total 154 pediatric Hodgkin lymphoma (HL) survivors uniformly treated with ABVD were clinically followed up as per institutional protocol. All participants were evaluated for cardiac, pulmonary, and thyroid function abnormalities by multigated acquisition scan (MUGA) scan, spirometry with diffusion capacity of lung for the uptake of carbon monoxide (DLCO), and thyroid profile test, respectively, at a single time point. Predictors of toxicity were also analyzed. RESULTS The median duration of follow-up of the cohort was 10.3 years (6.04-16.8). No secondary malignant neoplasm (SMN) or symptomatic cardiac/pulmonary toxicities were detected. Nine patients (5.9%) had left ventricular ejection fraction (LVEF) <55%. Subclinical and overt hypothyroidism were observed in 78 (50.6%) and 16 (10.4%) survivors, respectively. Abnormal spirometry and reduced DLCO was observed in 43.2% and 42.0% survivors, respectively. Receiving neck radiation was significantly associated with thyroid dysfunction (odds ratio [OR] 16.04, p < .001); age ≥10 years predicted reduced DLCO (OR 4.12, p = .001). Sixty-three and 33 patients had one and two late adverse effects, respectively; receiving neck radiation predicted development of multiple late effects (proportional OR 4.72, p < 0.001). Cumulative dose of chemotherapy did not predict toxicity. CONCLUSIONS Overall, ABVD appears safe in children at a relatively short follow-up. Long-term safety data are required before it can be adopted for treating pediatric HL patients. Children receiving neck radiation require close follow-up.
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Affiliation(s)
- Abhenil Mittal
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sainath Bhethanabhotla
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Myklebust MP, Thor A, Rosenlund B, Gjengstø P, Karlsdottir Á, Brydøy M, Bercea BS, Olsen C, Johnson I, Berg MI, Langberg CW, Andreassen KE, Kjellman A, Haugnes HS, Dahl O. Serum miR371 in testicular germ cell cancer before and after orchiectomy, assessed by digital-droplet PCR in a prospective study. Sci Rep 2021; 11:15582. [PMID: 34341387 PMCID: PMC8329070 DOI: 10.1038/s41598-021-94812-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022] Open
Abstract
MicroRNA-371a-3p (miR371) has been suggested as a sensitive biomarker in testicular germ cell cancer (TGCC). We aimed to compare miR371 with the classical biomarkers α-fetoprotein (AFP) and β-human chorionic gonadotropin (hCGβ). Overall, 180 patients were prospectively enrolled in the study, with serum samples collected before and after orchiectomy. We compared the use of digital droplet PCR (RT-ddPCR) with the quantitative PCR used by others for detection of miR371. The novel RT-ddPCR protocol showed high performance in detection of miR371 in serum samples. In the study cohort, miR371 was measured using RT-ddPCR. MiR371 detected CS1 of the seminoma and the non-seminoma sub-types with a sensitivity of 87% and 89%, respectively. The total sensitivity was 89%. After orchiectomy, miR371 levels declined in 154 of 159 TGCC cases. The ratio of miR371 pre- and post-orchiectomy was 20.5 in CS1 compared to 6.5 in systemic disease. AFP and hCGβ had sensitivities of 52% and 51% in the non-seminomas. MiR371 is a sensitive marker that performs better than the classical markers in all sub-types and clinical stages. Especially for the seminomas CS1, the high sensitivity of miR371 in detecting TGCC cells may have clinical implications.
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Affiliation(s)
- Mette Pernille Myklebust
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway.
| | - Anna Thor
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Benedikte Rosenlund
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Ása Karlsdottir
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Marianne Brydøy
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | | | - Christian Olsen
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Ida Johnson
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Mathilde I Berg
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | | | - Anders Kjellman
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UIT-The Arctic University, Tromsø, Norway
| | - Olav Dahl
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
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Zraik IM, Heß-Busch Y. [Management of chemotherapy side effects and their long-term sequelae]. Urologe A 2021; 60:862-871. [PMID: 34185118 DOI: 10.1007/s00120-021-01569-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
Various chemotherapies are used to treat testicular cancer. The most common therapy regimens are BEP (cisplatin, etoposide, bleomycin), carboplatin mono (AUC 7), PEI (cisplatin, etoposide, ifosfamide), TIP (cisplatin, ifosfamide, paclitaxel) and GOP (gemcitabine, oxaliplatin, paclitaxel). This is accompanied by acute and late toxicities. These include general side effects such as anemia, neutropenia, nausea, vomiting, diarrhea, mucositis or paravasation as well as special toxicities like ototoxicity, nephrotoxicity, pulmonary toxicity, neurotoxicity or Raynaud's syndrome. Since young men are usually affected, the possible long-term consequences such as hypogonadism, infertility or the metabolic syndrome are very relevant. Accordingly, adequate management of the possible side effects and long-term consequences in the context of the use of chemotherapy is essential.
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Affiliation(s)
- Isabella M Zraik
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| | - Yasmine Heß-Busch
- Klinik für Internistische Onkologie & Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
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10
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Stelwagen J, Lubberts S, Steggink LC, Steursma G, Kruyt LM, Donkerbroek JW, van Roon AM, van Gessel AI, van de Zande SC, Meijer C, Gräfin Zu Eulenburg CH, Oosting SF, Nuver J, Walenkamp AME, Jan de Jong I, Lefrandt JD, Gietema JA. Vascular aging in long-term survivors of testicular cancer more than 20 years after treatment with cisplatin-based chemotherapy. Br J Cancer 2020; 123:1599-1607. [PMID: 32921790 PMCID: PMC7686327 DOI: 10.1038/s41416-020-01049-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/23/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Late effects of cisplatin-based chemotherapy in testicular cancer survivors (TCS) include cardiovascular morbidity, but little data is available beyond 20 years. The objective was to assess vascular damage in very long-term TCS. METHODS TCS (treated with chemotherapy or orchiectomy only) and age-matched healthy controls were invited. Study assessment included vascular stiffness with ultrasound measurement of carotid-femoral pulse wave velocity (cf-PWV). RESULTS We included 127 TCS consisting of a chemotherapy group (70 patients) and an orchiectomy group (57 patients) along with 70 controls. Median follow-up was 28 years (range: 20-42). The cf-PWV (m/s) was higher in TCS than in controls (geometrical mean 8.05 (SD 1.23) vs. 7.60 (SD 1.21), p = 0.04). The cf-PWV was higher in the chemotherapy group than in the orchiectomy group (geometrical mean 8.39 (SD 1.22) vs. 7.61 (SD 1.21), p < 0.01). In the chemotherapy group cf-PWV increased more rapidly as a function of age compared to controls (regression coefficient b 7.59 × 10-3 vs. 4.04 × 10-3; p = 0.03). CONCLUSION Very long-term TCS treated with cisplatin-based chemotherapy show increased vascular damage compatible with "accelerated vascular aging" and continue to be at risk for cardiovascular morbidity, thus supporting the need for intensive cardiovascular risk management. CLINICAL TRIAL REGISTRATION The clinical trial registration number is NCT02572934.
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Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Lars C Steggink
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Lara M Kruyt
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Jan Willem Donkerbroek
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Arie M van Roon
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Anne I van Gessel
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Saskia C van de Zande
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Coby Meijer
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Joop D Lefrandt
- Department of Internal Medicine, division of Vascular Medicine, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands.
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11
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Fung C, Dinh PC, Fossa SD, Travis LB. Testicular Cancer Survivorship. J Natl Compr Canc Netw 2020; 17:1557-1568. [PMID: 31805527 DOI: 10.6004/jnccn.2019.7369] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
Testicular cancer (TC) is the most common cancer among men aged 18 to 39 years. It is highly curable, with a 10-year relative survival approaching 95% due to effective cisplatin-based chemotherapy. Given the increasing incidence of TC and improved survival, TC survivors (TCS) now account for approximately 4% of all US male cancer survivors. They have also become a valuable cohort for adult-onset cancer survivorship research, given their prolonged survival. Commensurately, long-term treatment-related complications have emerged as important survivorship issues. These late effects include life-threatening conditions, such as second malignant neoplasms and cardiovascular disease. Moreover, TCS can also experience hearing loss, tinnitus, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, infertility, anxiety, depression, cognitive impairment, and chronic cancer-related fatigue. Characterization of the number and severity of long-term adverse health outcomes among TCS remains critical to develop risk-stratified, evidence-based follow-up guidelines and to inform the development of preventive measures and interventions. In addition, an improved understanding of the long-term effects of TC treatment on mortality due to noncancer causes and second malignant neoplasms remains paramount. Future research should focus on the continued development of large, well-characterized clinical cohorts of TCS for lifelong follow-up. These systematic, comprehensive approaches can provide the needed infrastructure for further investigation of long-term latency patterns of various medical and psychosocial morbidities and for more in-depth studies investigating associated etiopathogenetic pathways. Studies examining premature physiologic aging may also serve as new frontiers in TC survivorship research.
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Affiliation(s)
- Chunkit Fung
- aUniversity of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul C Dinh
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.,cDepartment of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; and
| | | | - Lois B Travis
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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12
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Cullen M, Huddart R, Joffe J, Gardiner D, Maynard L, Hutton P, Mazhar D, Shamash J, Wheater M, White J, Goubar A, Porta N, Witts S, Lewis R, Hall E. The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis. Eur Urol 2020; 77:344-351. [PMID: 31901440 PMCID: PMC7026695 DOI: 10.1016/j.eururo.2019.11.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/26/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2), and cisplatin (BE360P) chemotherapy, or surveillance. OBJECTIVE To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P. DESIGN, SETTING, AND PARTICIPANTS A total of 246 patients with vascular invasion-positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study. INTERVENTION One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1-3, and cisplatin 50 mg/m2 on days 1-2, plus antibacterial and granulocyte colony stimulating factor prophylaxis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of ≥5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr. RESULTS AND LIMITATIONS The median follow-up was 49 mo (interquartile range 37-60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3-3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3-4 febrile neutropenia occurred in 6.8% of participants. CONCLUSIONS BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population. PATIENT SUMMARY Removing the testicle fails to cure many patients with high-risk primary testicular cancer since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes to those seen with two cycles.
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Affiliation(s)
- Michael Cullen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Huddart
- The Institute Of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | | | - Deborah Gardiner
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Lauren Maynard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Paul Hutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Matthew Wheater
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Aicha Goubar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Stephanie Witts
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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13
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Udupa CBK, Koteshwar P, Udupa KS. Bleomycin in Hodgkin's Lymphoma - A Boon or a Bane? - A Retrospective Study of Bleomycin Pulmonary Toxicity in Hodgkin's Lymphoma. Indian J Palliat Care 2019; 25:523-526. [PMID: 31673206 PMCID: PMC6812434 DOI: 10.4103/ijpc.ijpc_107_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Hodgkin's lymphoma (HL) is one of the most curable malignancies with cure rates of above 85% across all stages. Bleomycin containing regimen is routinely employed in the treatment of HL. Pulmonary toxicity due to this drug is the most feared side effect in these regimens where the mortality rate is approximately 2%–3%. We have conducted this study to assess the genetic susceptibility among the Indian HL patients to bleomycin pulmonary toxicity (BPT). Materials and Methods: In a retrospective study conducted at a tertiary care hospital from South India between January 2013 and May 2019, we reviewed 100 HL patients who were treated with bleomycin-containing regimen (adriamycin, bleomycin, vinblastine, and dacarbazine or cyclophosphamide, vincristine, procarbazine, and prednisone/adriamycin, bleomycin, and vinblastine) for BPT. Results: A total of 100 patients with HL who had received bleomycin-containing regimen were analyzed, which included 23 females and 77 males. Twenty-nine patients had BPT and five deaths were attributed to the same. Radiology reports showed that 15 patients had acute BPT and eight patients had chronic changes. Four patients had rare findings of bleomycin-induced lung damage and computed tomography of the chest could not be done for two patients, whose chest X-ray showed features suggestive of BPT. Conclusion: The incidence of bleomycin induced pulmonary toxicity and mortality was significantly higher in our study compared to that of other Western studies. This could be probably due to the increased susceptibility of the Indian patients to bleomycin induced lung damage. In a highly curable cancer such as HL, it is unacceptable to have such a high life-threating toxicity. Hence, an alternative chemotherapy regimen without bleomycin is to be explored which would prevent toxicity and hence the compromise on survival.
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Affiliation(s)
- Chethana Babu K Udupa
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prakashini Koteshwar
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Karthik S Udupa
- Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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14
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Lavoie JM, Kollmannsberger CK. Current Management of Disseminated Germ Cell Tumors. Urol Clin North Am 2019; 46:377-388. [DOI: 10.1016/j.ucl.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Stoneham S, Murray M, Thomas B, Williamson M, Sweeney C, Frazier L. AYA testis cancer: The unmet challenge. Pediatr Blood Cancer 2019; 66:e27796. [PMID: 31066223 DOI: 10.1002/pbc.27796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Testis cancer is considered a rare-incidence cancer but comprises the third most common cancer diagnosed within the adolescent and young adult (AYA) years (15-39 years). Most testis cancer patients can anticipate a survival outcome in excess of 95%. However, there are subgroups of AYA patients where outcomes are considerably worse, including younger adolescents, patients with certain histological subtypes, or from certain ethnic backgrounds. For those cured with chemotherapy, the toxicity of treatment and burden of late effects is significant. Newer germ cell tumor-specific biomarkers may identify patients who do not require further treatment interventions or may detect early recurrence, potentially reducing the burden of treatment required for cure. An international collaboration for this rare tumor is creating the forum for trial design, where these biomarker research questions are embedded. Going forward, AYA testis cancer patients could benefit from having a more personalized treatment plan, tailored to risk, that minimizes the overall burden of late effects.
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Affiliation(s)
- Sara Stoneham
- Department of Paediatrics and Child Health, University College Hospital London NHS Foundation Trust, London, UK
| | - Matthew Murray
- Department of Pathology, University of Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Benjamin Thomas
- Oncology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Max Williamson
- Life Sciences Faculty, University College London, London, UK
| | - Christopher Sweeney
- Dana-Farber Cancer Institute, Department of Medical Oncology and Division of Population Sciences, Boston, Massachusetts
| | - Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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16
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Joly F, Ahmed-Lecheheb D, Thiery-Vuillemin A, Orillard E, Coquan E. [Side effects of chemotherapy for testicular cancers and post-cancer follow-up]. Bull Cancer 2019; 106:805-811. [PMID: 31171345 DOI: 10.1016/j.bulcan.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/30/2023]
Abstract
Testicular cancers are the most frequent and the most curable cancers in young men. Treatments of these cancers represent a great success with cure rate over to 95 %. However, chemotherapy side effects may occur during or after several years post-treatment. This review aimed to highlight complications and physical and psychological side effects occurring mainly after chemotherapy treatment for testicular cancer, and to propose a personalized post-cancer plan specific for patients treated for testicular cancer. Treatments of these cancers can cause short-term complications (asthenia, nausea, vomiting, alopecia..). These side effects disappear within a few months after the end of the treatments. Late complications may occur several years post-treatment. Cardiovascular disease, metabolic syndrome and secondary neoplasia represent the most severe late effects among patients treated for testicular cancer. Given the increased incidence of these chemotherapy-induced side effects, it is indispensable to establish a specific follow up which must include a particular vigilance on the risk of occurrence of second cancer, a follow-up of the cardio-vascular risk factors, pulmonary and auditory follow-up, and early detection of psychosocial disorders.
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Affiliation(s)
- Florence Joly
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; CHU de Caen, Department of Oncology, 14000 Caen, France.
| | - Djihane Ahmed-Lecheheb
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France
| | | | - Emeline Orillard
- CHU Jean-Minjoz, Département Oncologie médicale, Boulevard Fleming, 25030 Besançon, France
| | - Elodie Coquan
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France
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17
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Indications, evolving technique, and early outcomes with robotic retroperitoneal lymph node dissection. Curr Opin Urol 2019; 28:461-468. [PMID: 29979235 DOI: 10.1097/mou.0000000000000530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Examine and discuss indications, technique, and outcomes for robotic retroperitoneal lymph node dissection (RPLND) for testicular cancer. RECENT FINDINGS Open RPLND has been the longstanding standard of care for both primary and post chemotherapy RPLND. Recently, robotic RPLND has been an attractive option with the intent of reducing the morbidity associated with open surgery while providing identical oncologic efficacy. Naysayers of robotic RPLND suggest it is often inappropriately used as a staging procedure and consequently can compromise oncologic efficacy. SUMMARY Robotic RPLND is being evaluated as a therapeutic equivalent to open RPLND. On the basis of limited published data with modest follow-up from experienced centers, robotic RPLND appears to provide effective staging and therapeutic data mirroring that of open surgery.
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18
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Seo YJ, Park H. Factors influencing caregiver burden in families of hospitalised patients with lung cancer. J Clin Nurs 2019; 28:1979-1989. [DOI: 10.1111/jocn.14812] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/11/2018] [Accepted: 12/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Ye Ji Seo
- College of Nursing, Research Institute of Nursing Science Keimyung University Daegu Korea
| | - Heeok Park
- College of Nursing, Research Institute of Nursing Science Keimyung University Daegu Korea
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19
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Schepisi G, De Padova S, De Lisi D, Casadei C, Meggiolaro E, Ruffilli F, Rosti G, Lolli C, Ravaglia G, Conteduca V, Farolfi A, Grassi L, De Giorgi U. Psychosocial Issues in Long-Term Survivors of Testicular Cancer. Front Endocrinol (Lausanne) 2019; 10:113. [PMID: 30858829 PMCID: PMC6397854 DOI: 10.3389/fendo.2019.00113] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/07/2019] [Indexed: 01/20/2023] Open
Abstract
Testicular cancer is the most frequent tumor in young males aged 15-39 years. As cure rates are currently around 90%, the prevalence of survivors is increasing. However, a disease-free condition does not necessarily correspond to a life free of physical and psychosocial health problems. The aim of this review was to explore psychosocial morbidity among testicular cancer survivors. A literature search was conducted in three electronic databases (PubMed, Medline, and Embase). The results of the search on cancer survivors were then combined with those of the search on psychosocial concerns and work performance. Eighty-four publications met the inclusion criteria. Physical, psychological, work-related problems and changing perspectives about work and life in general influenced life and career decisions among testicular cancer survivors. Individual health, sexual relationships and work problems, affect several important aspects of survival and significantly influence the QoL of long-term survivors.
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Affiliation(s)
- Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
- *Correspondence: Giuseppe Schepisi
| | - Silvia De Padova
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Delia De Lisi
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Chiara Casadei
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Giovanni Rosti
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Cristian Lolli
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Giorgia Ravaglia
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Alberto Farolfi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Luigi Grassi
- Hospital Psychiatry Unit, Department of Biomedical and Specialty Surgical Sciences, Integrated Department of Mental Health and Addictive Behavior, Institute of Psychiatry, St. Anna University Hospital and NHS Community Health Trusts, University of Ferrara, Ferrara, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
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20
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Development of a best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours in the UK. Br J Cancer 2018; 119:1044-1051. [PMID: 30356125 PMCID: PMC6219480 DOI: 10.1038/s41416-018-0300-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/06/2018] [Accepted: 09/20/2018] [Indexed: 11/08/2022] Open
Abstract
Bleomycin, a cytotoxic chemotherapy agent, forms a key component of curative regimens for lymphoma and germ cell tumours. It can be associated with severe toxicity, long-term complications and even death in extreme cases. There is a lack of evidence or consensus on how to prevent and monitor bleomycin toxicity. We surveyed 63 germ cell cancer physicians from 32 cancer centres across the UK to understand their approach to using bleomycin. Subsequent guideline development was based upon current practice, best available published evidence and expert consensus. We observed heterogeneity in practice in the following areas: monitoring; route of administration; contraindications to use; baseline and follow-up investigations performed, and advice given to patients. A best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours has been developed and includes recommendations regarding baseline investigations, the use of pulmonary function tests, route of administration, monitoring and patient advice. It is likely that existing heterogeneity in clinical practice of bleomycin prescribing has significant economic, safety and patient experience implications. The development of an evidence-based consensus guideline was supported by 93% of survey participants and aims to address these issues and homogenise practice across the UK.
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21
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Langberg MK, Berglund-Nord C, Cohn-Cedermark G, Haugnes HS, Tandstad T, Langberg CW. Imatinib may reduce chemotherapy-induced pneumonitis. A report on four cases from the SWENOTECA. Acta Oncol 2018; 57:1401-1406. [PMID: 29869895 DOI: 10.1080/0284186x.2018.1479072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND An increasing number of anticancer drugs have been reported to cause pneumonitis. Chemotherapy-induced pneumonitis may cause severe morbidity and event death. As there has been a lack of effective treatment, new treatment strategies are needed. A previous case report has indicated that imatinib may be useful. PATIENT AND METHODS The SWENOTECA experience of four cases with severe life-threatening chemotherapy-induced pneumonitis treated with imatinib is presented. RESULTS All four patients responded to treatment with imatinib. CONCLUSIONS Imatinib appears to be an effective treatment of severe chemotherapy-induced pneumonitis in germ cell cancer patients.
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Affiliation(s)
| | - Carina Berglund-Nord
- Department of Oncology–Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Gabriella Cohn-Cedermark
- Department of Oncology–Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Hege S. Haugnes
- Institute of Clinical Medicine - Oncology, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | | | - Carl W. Langberg
- Department of Oncology, University Hospital of Oslo, Oslo, Norway
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22
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Brunet J, Wurz A, Shallwani SM. A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer. Psychooncology 2018; 27:1875-1888. [PMID: 29719077 DOI: 10.1002/pon.4743] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Physical activity can improve health, functional capacity, and quality of life among children and adults diagnosed with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to: determine the extent, range, and nature of published studies on physical activity among AYAs; identify knowledge gaps; and provide directions for future research. METHODS We searched 4 electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full-texts against inclusion criteria: original research with humans, published in an English-language peer-reviewed journal, ≥50% of participants were diagnosed with cancer between the ages of 15 and 39 years, and included at least 1 measure of physical activity behavior. Data were extracted from studies meeting these criteria and subsequently summarized narratively. RESULTS Our search yielded 4729 articles; 32 met inclusion criteria. These included 18 cross-sectional and 4 longitudinal studies that explored descriptive (ie, sociodemographic or medical), physical, personal/psychological, social, other health behaviors, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behavior or on testing the effects of physical activity. CONCLUSIONS We can conclude that physical activity is not well researched among AYAs. More high-quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behavior change interventions as well as to establish the benefits of physical activity for AYAs.
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amanda Wurz
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors. Adv Urol 2018; 2018:8671832. [PMID: 29670654 PMCID: PMC5835297 DOI: 10.1155/2018/8671832] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022] Open
Abstract
Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.
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Maroto P, Anguera G, Martin C. Long-term toxicity of the treatment for germ cell-cancer. A review. Crit Rev Oncol Hematol 2018; 121:62-67. [DOI: 10.1016/j.critrevonc.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022] Open
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Chovanec M, Abu Zaid M, Hanna N, El-Kouri N, Einhorn LH, Albany C. Long-term toxicity of cisplatin in germ-cell tumor survivors. Ann Oncol 2017; 28:2670-2679. [PMID: 29045502 PMCID: PMC6246726 DOI: 10.1093/annonc/mdx360] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Testicular germ-cell tumors (GCT) are highly curable. A multidisciplinary approach, including cisplatin-based chemotherapy has resulted in cure in the majority of patients with GCT. Thus, the life expectancy of survivors will extend to many decades post-diagnosis. Late treatment toxicities associated with cisplatin-based chemotherapy may impact their future health. OBJECTIVE To systematically evaluate evidence regarding the long-term toxicity of cisplatin in GCT survivors. EVIDENCE ACQUISITION We carried out a critical review of PubMed/Medline in February 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) criteria. Eighty-three publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS Included reports evaluated long-term toxicities of cisplatin-based chemotherapy in GCT survivors. Studies reporting neuro- and ototoxicity, secondary malignancies, cardiovascular, renal and pulmonary toxicities, hypogonadism and infertility were found. Seven studies (8%) reported genetic underpinnings of long-term toxicities and 3 (4%) and 14 (19%) studies correlated long-term toxicities with circulating platinum levels and cumulative dose of cisplatin, respectively. Significant risks for long-term toxicities associated with cisplatin and platinum-based regimens were reported. The cumulative dose of cisplatin and circulating platinum were reported as risk factors. Several single-nucleotide polymorphisms identified patients susceptible to cisplatin compared with wild-type individuals. CONCLUSIONS GCT survivors cured with cisplatin-based chemotherapy are at risk for long-term side-effects. Detection of single-nucleotide polymorphisms could be a valuable tool for predicting long-term toxicities. PATIENT SUMMARY Herein, this article summarizes the available evidence of long-term toxicity of cisplatin-based chemotherapy in GCT survivors and provide insights from Indiana University.
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Affiliation(s)
- M Chovanec
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA;; 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia;; National Cancer Institute, Bratislava, Slovakia
| | - M Abu Zaid
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - N Hanna
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - N El-Kouri
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - L H Einhorn
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - C Albany
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA;.
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van Leeuwen M, Kieffer JM, Efficace F, Fosså SD, Bolla M, Collette L, Colombel M, De Giorgi U, Holzner B, van de Poll-Franse LV, van Poppel H, White J, de Wit R, Osanto S, Aaronson NK. International evaluation of the psychometrics of health-related quality of life questionnaires for use among long-term survivors of testicular and prostate cancer. Health Qual Life Outcomes 2017; 15:97. [PMID: 28490338 PMCID: PMC5426020 DOI: 10.1186/s12955-017-0670-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background Understanding of the physical, functional and psychosocial health problems and needs of cancer survivors requires cross-national and cross-cultural standardization of health-related quality of life (HRQoL) questionnaires that capture the full range of issues relevant to cancer survivors. To our knowledge, only one study has investigated in a comprehensive way whether a questionnaire used to evaluate HRQoL in cancer patients under active treatment is also reliable and valid when used among (long-term) cancer survivors. In this study we evaluated, in an international context, the psychometrics of HRQoL questionnaires for use among long-term, disease-free, survivors of testicular and prostate cancer. Methods In this cross-sectional study, we recruited long-term survivors of testicular and prostate cancer from Northern and Southern Europe and from the United Kingdom who had participated in two phase III EORTC clinical trials. Participants completed the SF-36 Health Survey, the EORTC QLQ-C30 questionnaire, the QLQ-PR25 (for prostate cancer) or the QLQ-TC26 (for testicular cancer) questionnaires, and the Impact of Cancer questionnaire. Testicular cancer survivors also completed subscales from the Nordic Questionnaire for Monitoring the Age Diverse Workforce. Results Two hundred forty-two men (66% response rate) were recruited into the study. The average time since treatment was more than 10 years. Overall, there were few missing questionnaire data, although scales related to sexuality, satisfaction with care and relationship concerns of men without partners were missing in more than 10% of cases. Debriefing showed that in general the questionnaires were accepted well. Many of the survivors scored at the upper extremes of the questionnaires, resulting in floor and ceiling effects in 64% of the scales. All of the questionnaires investigated met the threshold of 0.70 for group level reliability, with the exception of the QLQ-TC26 (mean reliability .64) and the QLQ-PR25 (mean reliability .69). The questionnaires were able to discriminate clearly between patients with and without comorbid conditions. Conclusions The currently available HRQoL questionnaires exhibit acceptable psychometric properties and were well received by patients, but additional efforts are needed to ensure that the full range of survivor-specific issues is assessed.
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Affiliation(s)
- Marieke van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Fabio Efficace
- Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, Via Benevento 6, Rome, Italy
| | - Sophie D Fosså
- Oslo University Hospital, Radiumhospital, National Advisory Unit on Late Effects after Cancer Treatment, Oslo, Norway
| | - Michel Bolla
- Department of Radiation Oncology, Centre Hospitalier Universitaire A Michallon, BP217, 38043, Grenoble cedex 09, France
| | | | - Marc Colombel
- Department of General Urology and Oncology, Hôpital Édouard Herriot, 5 Place d'Arsonval, Lyon, France
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
| | - Bernhard Holzner
- Department of Psychiatry, Innsbruck University Hospital, Sternwartestraße 15, Innsbruck, Austria
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, The Netherlands.,Comprehensive Cancer Organisation Netherlands (CCCS), Netherlands Cancer Registry, Zernikestraat 29, Eindhoven, The Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Hendrik van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Herestraat 49, Leuven, Belgium
| | - Jeff White
- The Beatson West of Scotland Cancer Center, Glasgow, Scotland
| | - Ronald de Wit
- Department of Medical Oncology, Rotterdam Cancer Institute (Dr Daniel den Hoed Kliniek) and Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, The Netherlands
| | - Susanne Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, The Netherlands.
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Abstract
Despite significant recent progress in precision medicine and immunotherapy, conventional chemotherapy remains the cornerstone of the treatment of most cancers. Chemotherapy-induced lung toxicity represents a serious diagnostic challenge for health care providers and requires careful consideration because it is a diagnosis of exclusion with significant impact on therapeutic decisions. This review aims to provide clinicians with a valuable guide in assessing their patients with possible chemotherapy-induced lung toxicity.
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Affiliation(s)
- Paul Leger
- Division of Internal Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, Nashville, TN 37232-2650, USA
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, Nashville, TN 37232-2650, USA.
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Morgan B, Stephenson JA, Griffin Y. Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer. Clin Radiol 2016; 71:1083-94. [PMID: 27522436 DOI: 10.1016/j.crad.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.
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Affiliation(s)
- B Morgan
- University of Leicester Imaging Department, Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Y Griffin
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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Oldenburg J, Gietema JA. The Sound of Silence: A Proxy for Platinum Toxicity. J Clin Oncol 2016; 34:2687-9. [PMID: 27382103 DOI: 10.1200/jco.2016.68.2476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Jan Oldenburg
- Akershus University Hospital, Lørenskog, Norway; and University of Oslo, Oslo, Norway
| | - Jourik A Gietema
- University of Groningen, University Medical Center Groningen, The Netherlands
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Lauritsen J, Kier MGG, Bandak M, Mortensen MS, Thomsen FB, Mortensen J, Daugaard G. Pulmonary Function in Patients With Germ Cell Cancer Treated With Bleomycin, Etoposide, and Cisplatin. J Clin Oncol 2016; 34:1492-9. [DOI: 10.1200/jco.2015.64.8451] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose For patients with germ cell cancer, various pulmonary toxicity risk factors have been hypothesized for treatment with bleomycin, etoposide, and cisplatin (BEP). Because existing studies have shortcomings, we present a large, unselected cohort of patients who have undergone close monitoring of lung function before, during, and after treatment with BEP to disclose valid pulmonary toxicity risk factors. Patients and Methods All patients who were treated with BEP at Rigshospitalet, Copenhagen, Denmark, from 1984 to 2007, were included. Pulmonary function tests (PFTs) that measured the diffusing capacity of the lungs for carbon monoxide (DLCO), forced expiratory volume in 1 second, and forced vital capacity were performed systematically before, during, and after treatment with BEP for 5 years of follow-up. According to local protocol, bleomycin was discontinued if hemoglobin-corrected DLCO (DLCOc) decreased ≥ 25% compared with pretreatment value. Covariates of possible importance were evaluated with a multiple regression analysis for pretreatment PFTs and with a mixed model for follow-up PFTs. Bleomycin was adjusted on the basis of PFT results and was thus omitted as covariate. Results Overall, 565 patients were evaluated with a PFT before or after treatment with BEP. During BEP, 15 patients died of progressive disease or toxicity, including one patient from bleomycin-induced pneumonitis. Post-treatment DLCOc decreased significantly, with a rebound during follow-up. Forced expiratory volume in 1 second and forced vital capacity remained unchanged after BEP but increased significantly to levels above pretreatment during follow-up. International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic group, mediastinal primary, pulmonary metastases, and smoking all significantly influenced baseline PFT results. Pulmonary surgery, pulmonary embolism, IGCCCG poor prognosis, and smoking influenced PFT during follow-up. Mediastinal primary, pulmonary metastases, age, or doses of cisplatin and etoposide had no influence on follow-up PFT, and renal function did not influence PFT. Conclusion After 5 years of follow-up, pulmonary impairment in patients with germ cell cancer who were treated with BEP was limited. Exceptions were patients treated with pulmonary surgery, those who suffered pulmonary embolism, and those in the IGCCCG poor prognostic group.
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Affiliation(s)
- Jakob Lauritsen
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Maria Gry Gundgaard Kier
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Mikkel Bandak
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Mette Saksø Mortensen
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Frederik Birkebæk Thomsen
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Jann Mortensen
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
| | - Gedske Daugaard
- Jakob Lauritsen, Maria Gry Gundgaard Kier, Mikkel Bandak, Mette Saksø Mortensen, Frederik Birkebæk Thomsen, Jann Mortensen, and Gedske Daugaard, Rigshospitalet; and Maria Gry Gundgaard Kier, Danish Cancer Society, Copenhagen, Denmark
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Shaikh F, Murray MJ, Amatruda JF, Coleman N, Nicholson JC, Hale JP, Pashankar F, Stoneham SJ, Poynter JN, Olson TA, Billmire DF, Stark D, Rodriguez-Galindo C, Frazier AL. Paediatric extracranial germ-cell tumours. Lancet Oncol 2016; 17:e149-e162. [PMID: 27300675 DOI: 10.1016/s1470-2045(15)00545-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/12/2022]
Abstract
Management of paediatric extracranial germ-cell tumours carries a unique set of challenges. Germ-cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ-cell tumours are managed by a diverse array of specialists. Thus, staging, risk stratification, and treatment approaches for germ-cell tumours have evolved disparately along several trajectories. Paediatric germ-cell tumours differ from the adolescent and adult disease in many ways, leading to complexities in applying age-appropriate, evidence-based care. Suboptimal outcomes remain for several groups of patients, including adolescents, and patients with extragonadal tumours, high tumour markers at diagnosis, or platinum-resistant disease. Survivors have significant long-term toxicities. The challenge moving forward will be to translate new insights from molecular studies and collaborative clinical data into improved patient outcomes. Future trials will be characterised by improved risk-stratification systems, biomarkers for response and toxic effects, rational reduction of therapy for low-risk patients and novel approaches for poor-risk patients, and improved international collaboration across paediatric and adult cooperative research groups.
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Affiliation(s)
- Furqan Shaikh
- Division of Haematology and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - James F Amatruda
- Department of Pediatrics, Department of Molecular Biology and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA
| | - Nicholas Coleman
- Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Juliet P Hale
- Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sara J Stoneham
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | | | - Daniel Stark
- Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | | | - A Lindsay Frazier
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
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Lauritsen J, Kier MG, Mortensen MS, Bandak M, Gupta R, Holm NV, Agerbaek M, Daugaard G. Germ Cell Cancer and Multiple Relapses: Toxicity and Survival. J Clin Oncol 2015; 33:3116-23. [DOI: 10.1200/jco.2014.60.1310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose A small number of patients with germ cell cancer (GCC) receive more than one line of treatment for disseminated disease. The purpose of this study was to evaluate late toxicity and survival in an unselected cohort of patients who experienced relapse after receiving first-line treatment for disseminated disease. Methods From the Danish Testicular Cancer database, we identified all patients who received more than one line of treatment for disseminated disease. Information about late toxicity and mortality was obtained by means of linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification. Results In total, 268 patients received more than one line of treatment for disseminated GCC. Approximately half of patients (n = 136) died as a result of GCC. The 132 remaining patients, compared with patients treated with only orchiectomy, had an increased risk for a second cancer (hazard ratio [HR], 3.2; 95% CI, 1.9 to 5.5), major cardiovascular disease (HR, 1.9; 95% CI, 1.0 to 3.3), pulmonary disease (HR, 2.0; 95% CI, 1.0 to 3.8), GI disease (HR, 7.3; 95% CI, 3.6 to 14.8), renal impairment (HR, 8.3; 95% CI, 3.0 to 23.2), neurologic disorders (HR, 6.3; 95% CI, 3.1 to 12.6), and death as a result of other causes (HR, 2.6; 95% CI, 1.6 to 4.2). In large part, the IPFSG classification was confirmed in our population; however, we could not confirm the primary site and the level of human chorionic gonadotropin as independent factors. We identified increasing age as a possible new prognostic factor for treatment failure after second-line treatment (HR, 1.2 per 10 years; 95% CI, 1.2 to 15). Conclusion Patients with GCC who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than GCC. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.
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Affiliation(s)
- Jakob Lauritsen
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Maria G.G. Kier
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Mette S. Mortensen
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Bandak
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Ramneek Gupta
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Niels V. Holm
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Agerbaek
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
| | - Gedske Daugaard
- Jakob Lauritsen, Maria G.G. Kier, Mette S. Mortensen, Mikkel Bandak, and Gedske Daugaard, Copenhagen University Hospital, Copenhagen; Maria G.G. Kier, Danish Cancer Society Research Center, Strandboulevarden, Copenhagen; Ramneek Gupta, Technical University of Denmark, Kongens Lyngby; Niels V. Holm, Odense University Hospital, Odense; and Mads Agerbaek, Aarhus University Hospital, Aarhus, Denmark
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Fung C, Fossa SD, Williams A, Travis LB. Long-term Morbidity of Testicular Cancer Treatment. Urol Clin North Am 2015. [DOI: 10.1016/j.ucl.2015.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Haugnes HS, Oldenburg J, Bremnes RM. Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors. Urol Oncol 2014; 33:399-406. [PMID: 25554583 DOI: 10.1016/j.urolonc.2014.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 01/27/2023]
Abstract
Testicular cancer (TC) is the most common solid organ malignancy among young men at their peak of family life, education, and career. The exceptionally high cure rates are hampered by an increased risk of several treatment-related toxicities that may emerge several years after treatment. In this article, we review the current knowledge regarding pulmonary and cardiovascular toxicity in long-term survivors of TC. Bleomycin pulmonary toxicity is associated with the cumulative bleomycin dose, renal function, age and smoking status and can be avoided by a careful patient evaluation before chemotherapy. Lung function assessments are not routinely recommended for detecting bleomycin pulmonary toxicity. Long-term decreased pulmonary function may also be related to other chemotherapy agents such as cisplatin. Cardiovascular disease represents one of the most serious late effects of cytotoxic treatment in TC survivors and typically appears several years to decades after treatment. The increased risk for cardiovascular disease is probably mediated by a direct vascular damage from cytotoxic treatment that may stimulate the endothelium, possibly ultimately inducing the atherosclerotic process, as well as an indirect cytotoxic effect by increasing the levels of cardiovascular risk factors. Follow-up of these cancer survivors should include recommendations for maintaining a healthy lifestyle to reduce the risk of future cardiovascular events and to avoid declining pulmonary function.
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Affiliation(s)
- Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Jan Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Oldenburg J, Aparicio J, Beyer J, Cohn-Cedermark G, Cullen M, Gilligan T, De Giorgi U, De Santis M, de Wit R, Fosså SD, Germà-Lluch JR, Gillessen S, Haugnes HS, Honecker F, Horwich A, Lorch A, Ondruš D, Rosti G, Stephenson AJ, Tandstad T. Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol 2014; 26:833-838. [PMID: 25378299 DOI: 10.1093/annonc/mdu514] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/28/2014] [Indexed: 11/12/2022] Open
Abstract
Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ∼99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable long-term survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting a uniform recommendation for all.
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Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Department of Oncology, University of Oslo, Oslo, Norway.
| | - J Aparicio
- Department of Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Beyer
- Department of Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Cullen
- Department of Medical Oncology, Queen Elizabeth Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - T Gilligan
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, USA
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - M De Santis
- Kaiser Franz Josef Hospital and ACR-ITR and LBI-ACR Vienna-CTO, Vienna, Austria
| | - R de Wit
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S D Fosså
- Department of Oncology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J R Germà-Lluch
- Department of Oncology, Institut Català d'Oncologia, Gran Via de l'Hospitalet Hospitalet de Llobregat, Barcelona, Spain
| | - S Gillessen
- Department of Medical Oncology, Kantonsspital, St Gallen, Switzerland
| | - H S Haugnes
- Oncology Department, University Hospital of North Norway, Tromsø, Norway
| | - F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland
| | - A Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - A Lorch
- Klinik für Urologie, konservative Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D Ondruš
- Department of Oncology, Comenius University Faculty of Medicine, St Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - G Rosti
- Medical Oncology, Ospedale Generale, Treviso, Italy
| | | | - T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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Tandstad T, Ståhl O, Håkansson U, Dahl O, Haugnes HS, Klepp OH, Langberg CW, Laurell A, Oldenburg J, Solberg A, Söderström K, Cavallin-Ståhl E, Stierner U, Wahlquist R, Wall N, Cohn-Cedermark G. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 2014; 25:2167-2172. [PMID: 25114021 DOI: 10.1093/annonc/mdu375] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. PATIENTS AND METHODS In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. RESULTS At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. CONCLUSIONS The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
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Affiliation(s)
- T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - U Håkansson
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - O Dahl
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen; Haukeland University Hospital, Bergen
| | - H S Haugnes
- Institute of Clinical Medicine, University of Tromsø, Tromsø; University Hospital of North Norway, Tromsø
| | - O H Klepp
- Department of Oncology, Ålesund Hospital, Ålesund
| | - C W Langberg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Laurell
- Department of Oncology, Uppsala University Hospital, Uppsala
| | - J Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Solberg
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - K Söderström
- The Cancer Clinic, Norrland University Hospital, Umeå
| | | | - U Stierner
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - R Wahlquist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - N Wall
- Institute of Clinical and Experimental Medicine, University of Linköping, Linköping
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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Sprauten M, Brydøy M, Haugnes HS, Cvancarova M, Bjøro T, Bjerner J, Fosså SD, Oldenburg J. Longitudinal Serum Testosterone, Luteinizing Hormone, and Follicle-Stimulating Hormone Levels in a Population-Based Sample of Long-Term Testicular Cancer Survivors. J Clin Oncol 2014; 32:571-8. [DOI: 10.1200/jco.2013.51.2715] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess longitudinal long-term alterations of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in testicular cancer survivors (TCSs). Patients and Methods In all, 307 TCSs treated from 1980 to 1994 provided blood samples after orchiectomy but before further treatment, at Survey I (SI; 1998-2002), and Survey II (SII; 2007-2008). Levels of sex hormones were categorized according to quartiles and reference range (2.5 and 97.5 percentiles) of 599 controls for each decadal age group. TCSs were categorized according to treatment: surgery, radiotherapy (RT), or chemotherapy (CT). The risk of higher (LH) or lower (testosterone) levels was assessed with χ2 test (FSH) or ordinal logistic regression analysis and expressed as odds ratios (ORs) with 95% CIs. Results Risk of lower testosterone and higher LH and FSH levels was significantly increased for TCSs at all time points after RT or CT. At SII, ORs were 3.3 (95% CI, 2.3 to 4.7) for lower testosterone categories and 5.2 (95% CI, 3.5 to 7.9) for RT and CT. ORs for increased LH and FSH were 4.4 (95% CI, 3.1 to 6.5) and 18.9 (95% CI, 11.0 to 32.6) for RT, respectively, and 3.6 (95% CI, 2.4 to 5.3) and 14.2 (95% CI, 8.3 to 24.4) for CT, respectively. The cumulative platinum dose was significantly associated with risk of higher LH levels at both surveys and higher FSH at SI. In total, half the TCSs had at least one of three sex hormone levels outside the reference range at SII. Conclusion Long-term TCSs are at risk of premature hormonal aging. Our findings may pertain to cancer survivors in general, underlining the importance of extended follow-up.
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Affiliation(s)
- Mette Sprauten
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Marianne Brydøy
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Hege S. Haugnes
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Milada Cvancarova
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Trine Bjøro
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Johan Bjerner
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Sophie D. Fosså
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
| | - Jan Oldenburg
- Mette Sprauten, Milada Cvancarova, Sophie D. Fosså, and Jan Oldenburg, Oslo University Hospital; Trine Bjøro, Oslo University Hospital and University of Oslo; Johan Bjerner, Fürst Medical Laboratory, Oslo; Marianne Brydøy, University of Bergen, Bergen; and Hege S. Haugnes, University of Tromsø and University Hospital of North Norway, Tromsø, Norway
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Aakre BM, Efem RI, Wilson GA, Kor DJ, Eisenach JH. Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin. Mayo Clin Proc 2014; 89:181-9. [PMID: 24485131 PMCID: PMC3987121 DOI: 10.1016/j.mayocp.2013.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/15/2013] [Accepted: 11/12/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the incidence and risk factors for postoperative acute respiratory distress syndrome (ARDS) in a large cohort of bleomycin-exposed patients undergoing surgery with general endotracheal anesthesia. PATIENTS AND METHODS From a Mayo Clinic cancer registry, we identified patients who had received systemic bleomycin and then underwent a major surgical procedure that required more than 1 hour of general anesthesia from January 1, 2000, through August 30, 2012. Heart, lung, and liver transplantations were excluded. Postoperative ARDS (within 7 days after surgery) was defined according to the Berlin criteria. RESULTS We identified 316 patients who underwent 541 major surgical procedures. Only 7 patients met the criteria for postoperative ARDS; all were white men, and 6 were current or former smokers. On univariate analysis, we observed an increased risk of postoperative ARDS in patients who were current or former smokers. Furthermore, significantly greater crystalloid and colloid administration was found in patients with postoperative ARDS. We also observed a trend toward longer surgical duration and red blood cell transfusion in patients with postoperative ARDS, although this finding was not significant. Intraoperative fraction of inspired oxygen was not associated with postoperative ARDS. In bleomycin-exposed patients, the incidence of postoperative ARDS after major surgery with general anesthesia is approximately 1.3% (95% CI, 0.6%-2.6%). For first major procedures after bleomycin therapy, the incidence is 1.9% (95% CI, 0.9%-4.1%). CONCLUSION The risk of postoperative ARDS in patients exposed to systemic bleomycin appears to be lower than expected. Smoking status may be an important factor that modifies the risk of postoperative ARDS in these patients.
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Affiliation(s)
| | - Richard I Efem
- Stony Brook University School of Medicine, Stony Brook, NY
| | | | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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Haugnes HS, Stephenson AJ, Feldman DR. Beyond stage I germ cell tumors: current status regarding treatment and long-term toxicities. Am Soc Clin Oncol Educ Book 2014:e180-e190. [PMID: 24857101 DOI: 10.14694/edbook_am.2014.34.e180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Approximately 20% to 40% of patients with germ-cell tumors (GCT) will need advanced medical treatment because of relapse or initial metastatic disease. The survival and recommended treatment for men with metastatic disease varies according to histology, primary and metastatic sites, and the level of prechemotherapy tumor markers. For patients with a good prognosis, three cycles of bleomycin, etoposide, and cisplatin (BEP) or four cycles of etoposide, and cisplatin are recommended. For patients with intermediate- and poor prognosis, four cycles of bleomycin, etoposide, and cisplatin remains the preferred treatment option, although a switch to a more intensive regimen can be considered a new alternative. A major advance in salvage therapy for GCT in the last 5 years was the development of a new risk classification system. Initial salvage treatment includes both high-dose chemotherapy and standard-dose chemotherapy. There is clear consensus that patients with residual masses larger than 1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND); however, the role of PC-RPLND in patients with serologic and radiographic complete response to first-line chemotherapy is controversial. The rationale for PC-RPLND in patients with small residual masses is discussed, and only a small minority of advanced nonseminoma GCT (NSGCT) patients are suitable candidates for observation after first-line chemotherapy. Post-treatment long-term toxicity has emerged as an important issue for GCT survivors. Examples of late effects are secondary nongerm-cell cancers and cardiovascular disease, which represent the most severe and potentially life-threatening effects of cancer treatment. Follow-up of cancer survivors should include recommendations for maintaining a healthy lifestyle to reduce the risk of serious long-term and late effects of treatment.
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Affiliation(s)
- Hege Sagstuen Haugnes
- From the Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Stephenson
- From the Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren Richard Feldman
- From the Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
Bleomycin is a chemotherapeutic agent commonly used to treat curable diseases such as germinative tumors and Hodgkin’s lymphoma. The major limitation of bleomycin therapy is pulmonary toxicity, which can be life threatening in up to 10% of patients receiving the drug. The mechanism of bleomycin-induced pneumonitis (BIP) involves oxidative damage, relative deficiency of the deactivating enzyme bleomycin hydrolase, genetic susceptibility, and the elaboration of inflammatory cytokines. Ultimately, BIP can progress to lung fibrosis. The diagnosis of BIP is established by the combination of systemic symptoms, radiological and histological findings, and respiratory function tests abnormalities, while other disorders should be excluded. Although the diagnosis and pathophysiology of this disease have been better characterized over the past few years, there is no effective therapy for the disease. In general, the clinical picture is extremely complex. A greater understanding of the BIP pathogenesis may lead to the development of new agents capable of preventing or even treating the injury already present. Physicians who prescribe bleomycin must be aware of the potential pulmonary toxicity, especially in the presence of risk factors. This review will focus on BIP, mainly regarding recent advances and perspectives in diagnosis and treatment.
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Clinical outcomes in patients with stage I non-seminomatous germ cell cancer. Asian J Androl 2013; 15:558-63. [PMID: 23685909 DOI: 10.1038/aja.2013.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/03/2013] [Accepted: 01/26/2013] [Indexed: 11/08/2022] Open
Abstract
This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance, retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months (range: 6-149 months). Thirteen of the 89 patients (14.6%) had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.
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Zarogoulidis P, Kerenidi T, Huang H, Kontakiotis T, Tremma O, Porpodis K, Kalianos A, Rapti A, Foroulis C, Zissimopoulos A, Courcoutsakis N, Zarogoulidis K. Six minute walking test and carbon monoxide diffusing capacity for non-small cell lung cancer: easy performed tests in every day practice. J Thorac Dis 2013. [PMID: 23205280 DOI: 10.3978/j.issn.2072-1439.2012.08.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several studies have demonstrated that reduced lung function is a significant risk factor for lung cancer and increased surgical risk in patients with operable stages of lung cancer. The aim of the study was to perform pulmonary function tests and investigate which is a favorable respiratory function test for overall survival between lung cancer stages. METHODS Lung function tests were performed to lung cancer patients with non-small cell lung cancer of stage I, II, III and IV (241 patients in total). They had the last follow-up consecutively between December 2006 and July 2008. The staging was decided according to the sixth edition of TNM classification of NSCLC. The Forced Expiratory Volume in 1sec (FEV1), Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO) were measured according to American Thoracic Society/European Respiratory Society guidelines. The 6 Minute Walking Test (6MWT) was measured according to the American Thoracic Society. RESULTS There was a significant association of the DLCO upon diagnosis and overall survival for stage II (P<0.007) and IV (P<0.003). Furthermore, there was a significant association between 6MWT and overall survival for stage III (P<0.001) and stage IV (P<0.010). CONCLUSIONS The significance for each lung function test is different among the stages of NSCLC. DLCO and 6MWT upon admission are the most valuable prognostic factors for overall survival of NSCLC.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Singhera M, Lees K, Huddart R, Horwich A. Minimizing toxicity in early-stage testicular cancer treatment. Expert Rev Anticancer Ther 2012; 12:185-93. [PMID: 22316366 DOI: 10.1586/era.11.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Testicular cancer is the paradigm of a curable malignancy, with 10-year survival rates exceeding 95%. Cisplatin-based regimes offer a survival gain of several decades of life; however, measures of outcomes in testicular cancer are evolving. Survivorship issues are becoming increasingly important in this young adult population. Long-term risks of second malignancy and cardiovascular disease secondary to chemotherapy and radiotherapy have been extensively documented, leading to an increased uptake of surveillance. However, the optimal surveillance schedule is not universally agreed upon. Research into modalities to detect relapse and frequency is ongoing. Reducing the treatment burden with fewer cycles of chemotherapy (one cycle of bleomycin, cisplatin and etoposide instead of two for stage I high-risk nonseminomatous tumors) or less toxic alternatives (carboplatin instead of radiotherapy for stage I seminomas) is currently being explored. This article details the toxicities associated with the diagnosis and treatments of early-stage testicular cancer and current strategies used to minimize toxicity while retaining the excellent cure rates.
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Affiliation(s)
- Mausam Singhera
- Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
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45
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Haugnes HS, Bosl GJ, Boer H, Gietema JA, Brydøy M, Oldenburg J, Dahl AA, Bremnes RM, Fosså SD. Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up. J Clin Oncol 2012; 30:3752-63. [PMID: 23008318 DOI: 10.1200/jco.2012.43.4431] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Germ cell testicular cancer (TC) represents a malignancy with high cure rates. Since the introduction of cisplatin-based chemotherapy in the late 1970s, the 5-year survival rate has increased considerably, and it is currently above 95%. Because TC is usually diagnosed before the age of 40 years, these men can expect to live for another 40 to 50 years after being successfully treated. This success, however, is hampered by an increased risk of long-term and late effects of treatment. Secondary malignant neoplasms and cardiovascular disease represent the most common potentially life-threatening late effects, typically occurring more than 10 years after treatment. Other long-term effects include pulmonary toxicity, nephrotoxicity, neurotoxicity, decreased fertility, hypogonadism, and psychosocial problems. The incidence and time to onset of these various adverse effects vary according to treatment type and intensity. There is still little knowledge about underlying mechanisms and genetic susceptibility of the various adverse effects. Apart from treatment burden, it is not yet possible to identify patients who are at high risk for certain late effects after TC treatment. In this clinical review, we present the current status regarding different somatic and psychosocial long-term late effects after treatment for TC, based on Medline searches and our own research. Moreover, we postulate recommendations for general medical evaluations that should begin after treatment is completed and continue during follow-up.
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Affiliation(s)
- Hege S Haugnes
- Oncology Department, University Hospital of North Norway, Tromsø, Norway.
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Williams S, Kacker R, Winston D, Bahnson E, Steele G, Richie J. Predictors of Positive Retroperitoneal Lymph Nodes in Patients With High Risk Testicular Cancer. J Urol 2011; 186:2245-8. [DOI: 10.1016/j.juro.2011.07.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Indexed: 11/29/2022]
Affiliation(s)
- S.B. Williams
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R. Kacker
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - D. Winston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E. Bahnson
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - G.S. Steele
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J.P. Richie
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Doi M, Okamoto Y, Yamauchi M, Naitou H, Shinozaki K. Bleomycin-induced pulmonary fibrosis after tumor lysis syndrome in a case of advanced yolk sac tumor treated with bleomycin, etoposide and cisplatin (BEP) chemotherapy. Int J Clin Oncol 2011; 17:528-31. [PMID: 22127348 DOI: 10.1007/s10147-011-0356-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
Ovarian yolk sac tumor (YST) is a highly aggressive malignancy arising in young women. Chemotherapy has dramatically improved the prognosis, and bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy appears to be the most effective combination regimen. A 23-year-old woman was admitted to our hospital with worsening abdominal distention and a lower abdominal mass. She was diagnosed with a stage IIIc pure YST of the right ovary, and right salpingo-oophorectomy was performed; there were numerous disseminated peritoneal tumors within the abdominal cavity. A few days postoperatively, massive ascites developed, and right hydronephrosis occurred. Chemotherapy with BEP was started, and after 24 h of administration, oliguria and tumor lysis syndrome (TLS) developed. Continuous hemodiafiltration was started, and hemodialysis was initiated following full-dose standard cisplatin and etoposide on days 2-5 of the 1st cycle. After the electrolyte abnormalities and the elevation of creatinine became normal, the patient received an additional three cycles of BEP and achieved complete remission. However, she also suffered from severe non-hematological toxicities, including grade 3 left ventricular dysfunction and grade 4 pulmonary fibrosis. In the case of rapidly progressing and high-volume YST treated with BEP chemotherapy, special attention should be paid to bleomycin-induced pulmonary toxicity following TLS. Further study is required to optimize drug exposure to ensure efficacy and reduce the risk of side effects in this population.
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Affiliation(s)
- Mihoko Doi
- Department of Clinical Oncology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan.
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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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