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Annals of Oncology 13:229-236, 2002
© 2002 European Society for Medical Oncology

Evaluation of long-term toxicity in patients after cisplatin-based chemotherapy for non-seminomatous testicular cancer

D. Strumberg,+, S. Brügge, M. W. Korn, S. Koeppen1, J. Ranft2, G. Scheiber3, C. Reiners4,§, C. Möckel5, S. Seeber and M. E. Scheulen

Department of Internal Medicine (Cancer Research), West German Cancer Center, 1Department of Neurology, 2Department of Angiology, 3Department of Anesthesiology, 4Clinic for Nuclear Medicine and 5Department of Otorhinolaryngology, University of Essen, Essen, Germany

Received 2 May 2001; revised 17 August 2001; accepted 19 September 2001.

Background

Because of the increasing number of long-term survivors of metastatic testicular germ-cell cancer, a general concern has been secondary morbidities, especially cardiovascular risk factors.

Patients and methods

Thirty-two patients treated with cisplatin- and doxorubicin-containing chemotherapy >=13 years before the time of analyses were evaluated for neuro-, oto-, pulmonary-, vascular- and gonadal toxicity including evaluation of myocardial damage and cardiovascular risk factors and analysis of microcirculation.

Results

Thirty percent of the patients showed abnormal left ventricle function. Elevated follicle stimulating hormone (FSH) and luteinising hormone (LH) levels in 75% of patients were often associated with low testosterone levels. Elevated total cholesterol levels were found in 82% and higher triglyceride levels in 44% of patients, most of them were overweight. About 25% of the patients developed diastolic arterial hypertension after chemotherapy.

Reduced hearing was confirmed in 23% of patients, especially at frequencies higher than 3000 Hz. Moreover, 53% of patients presented transient evoked otoacoustic emissions.

In 38% of patients non-symptomatic neuropathy was detected, in 28% symptomatic neuropathy, and in 6% disabling polyneuropathy. In 80% of patients with neuropathic symptoms additional morphological and functional abnormalities were found by nailfold capillary videomicroscopy, compared to only 57% of the patients without neuropathic symptoms.

Conclusions

Patients cured by cisplatin-based chemotherapy for metastatic testicular cancer have to be cognizant of their unfavorable cardiovascular risk profile, that might be a greater risk than developing a relapse or second malignancy.

Key words: cardiovascular risk, chemotherapy, cisplatin, long-term toxicity, testicular cancer


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