Clinical and Biochemical Long–Term Toxicity after Postoperative Cisplatin–Based Chemotherapy in Patients with Low-Stage Testicular Cancer

Abstract

In this case-control study the long-term chemotherapy-related morbidity was assessed in testicular cancer patients (≥5 years after treatment). The case group consisted of 47 patients with nonseminomatous testicular cancer who had undergone retroperitoneal surgery and 3-4 cycles of conventional-dose cisplatin-based chemotherapy (accumulated cisplatin dose: 300-400 mg/m²), also containing vinblastine and bleomycin. The results of the clinical and biochemical investigations and the patients’ responses to a questionnaire were compared to similar observations from a control group comprising 47 patients treated with surgery only. In the case group the serum magnesium values and the levels of FVIIvWF were significantly lower (but within the normal range) than in the control group. Serum cholesterol values were distributed similarly in both groups. About 40% of the patients from the chemotherapy group still suffered from Raynaud-like phenomena and/or sensoric neurotoxicity as compared to 10% of the patients from the control group. Chemotherapy resulted in a significant elevation of serum LH within the normal range, probably associated with a slight suclinical Leydig cell dysfunction. Serum FSH levels were similar in the case and control groups, indicating an absence of long-term disturbance of spermatogenesis after chemotherapy. No increased cardiovascular morbidity was observed as a result of chemotherapy. Raynaud-like phenomena and sensoric neurotoxicity represent the principal clinical long-term side effects after 3–4 cycles of cisplatin-based chemotherapy containing vinblastine and bleomycin. Serum LH is slightly elevated after chemotherapy, whereas long-term spermatogenesis seems to be unaffected.

Risk factors for post-treatment hypogonadism in testicular cancer patients.

“…A Leydig cell impairment, with subnormal/normal s-testosterone values and/or increased luteinizing hormone (LH), was found in patients who had undergone chemotherapy (5)(6)(7)(8). However, in other studies, no difference in testosterone or LH after chemotherapy was found (9,10).…”

Does cisplatin-based chemotherapy effect on blood lipid levels of patients with germ cell testicular tumor in long-term follow-up?

“…Although a great number of studies have been published about the long-term adverse effects of chemotherapy such as nephrotoxicity [7], renal magnesium wasting [8], Raynaud's phenomenon [9], neurotoxicity [10], gonadal dysfunction [11], and unfavorable cardiovascular risk factors including hypertension, overweight, and hypercholesterolemia [12,13], some of the findings are contradictory. Besides, the long-term quality of life of these patients following chemotherapy has gained importance, and studies questioning this quality which include the physical, psychological, and social functions of the patient have been carried out [14].…”

p12CDK2-AP1 mediates DNA damage responses induced by cisplatin

“…There are several limitations associated with the use of cisplatin (Kim and Glisson, 2003;Milas et al, 2003). There are serious side effects, notably renal toxicity, emesis, neurotoxicity, bone marrow suppression, and hearing loss (Tsutsumi et al, 1991;Fossa et al, 1995). Another major impediment to the clinical success of cisplatin is cellular resistance to the drug, through either intrinsic or acquired resistance .…”