Sequelae of Treatment in Long-term Survivors of Testis Cancer

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.

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.