Collaborative Review – Testis CancerSequelae of Treatment in Long-term Survivors of Testis Cancer
Introduction
The treatment of testicular cancer is a true medical success story and is viewed as a paradigm for curable adult cancer. Successful treatment approaches—in particular, the introduction of cisplatinum-based chemotherapy—have resulted in an overall 10-yr disease-specific survival of >95% [1]. Because of the young age at diagnosis, survivors can be expected to live an additional 50–60 yr or more. Therefore, there has been an increased focus on the long-term sequelae of treatment. Late effects of the treatment of testicular cancer include but are not restricted to cardiovascular disease, pulmonary toxicity, nephrotoxicity, neurotoxicity, reproductive disorders, and secondary malignancies. These are typically grouped into life- or health-threatening conditions (eg, secondary malignancies, cardiovascular disease) and quality of life (QoL) conditions (eg, infertility, fatigue). Increasing awareness of these potential morbidities has led to risk-adapted treatment strategies that aim to decrease treatment-related toxicity while maintaining efficacy. These strategies include radiation dose and field reductions in the treatment of seminoma [2], the development of nerve-sparing retroperitoneal lymph node dissection (RPLND) [3], the adoption of active surveillance in the treatment of nonmetastatic disease [4], and a reduction in the number of chemotherapy cycles in favorable-risk patients [5], [6]. Despite this change, however, long-term morbidity from treatment continues to be an issue in these relatively young patients.
This review aims to synthesize the literature examining secondary malignancies and treatment-related morbidity in long-term survivors of testicular cancer as well as the psychosocial effect of treatment. Awareness of these long-term complications by health professionals will, in these young patients, promote the use of less toxic treatment and lead to the prevention and early treatment of adverse effects in testicular cancer survivors (TCS) who are at risk for developing such sequelae.
Section snippets
Evidence acquisition
A Medline search of the medical literature was conducted to identify original articles and reviews on the long-term effects of testicular cancer treatment. The search included articles from January 1948 to February 2011; however, articles published in the past two decades were preferentially included. The following Medline subject headings and/or keywords were included as search terms: testicular neoplasms; neoplasms, germ cell and embryonal; seminoma; radiation injuries; postoperative
Cardiovascular
Patients with testicular cancer treated with chemotherapy have been reported to experience vascular complications, including pulmonary emboli, myocardial infarction (MI), venous thrombosis, and the Raynaud phenomenon [7], [8], [9]. Potential physiologic mechanisms underlying these conditions include increased serum cholesterol demonstrated after chemotherapy [10], [11] and/or direct vascular injury from chemotherapy or radiation. An increase in the number of circulating endothelial cells and
Conclusions
Advances in the treatment of testicular cancer have led to high cure rates and prolonged survival in patients with this condition. Although the early toxicity of treatments is acutely evident, it was not until more recently that long-term toxicities were being recognized. It is likely that the scope of the long-term treatment effects is still not fully appreciated. This review emphasizes the need for lifelong follow-up of TCSs by health professionals aware of the risk of long-term adverse
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