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

Strumberg, Dirk; Brugge, Simone van der Sar–van der; Korn, Michael; Koeppen, Susanne; Ranft, J; Scheiber, G.; Reiners, C.; Möckel, Christina; Seeber, S.; Scheulen, M. E.

doi:10.1093/annonc/mdf058

Cited by 214 publications

(142 citation statements)

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“…24,25 The incidence of late symptomatic neurotoxicity and ototoxicity is comparable to the reported frequencies in previous studies with standard-dose chemotherapy, while no patient presented cardiac or renal failure. 26 The results of our experience are comparable to those reported in other studies with early HDCT in GCT patients with poor prognosis disease, as defined by the IGCCCG criteria, but for the first time we confirmed the outcome of these patients at long-term follow-up. [16][17][18] However, despite the favorable results of these studies, the only randomized trial published so far, comparing HDCT (high-dose cisplatin, etoposide, cyclophosphamide) as late intensification after three courses of cisplatin, vinblastine, etoposide, and bleomycin (PVeEB) with four courses of PVeEB, showed no benefit for the HDCT arm.…”

Section: Discussionsupporting

confidence: 87%

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Giorgi

Rosti

Papiani

et al. 2004

Bone Marrow Transplant

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Summary:The 5-year overall survival rate of patients with germ cell tumor (GCT) with poor prognosis, according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, is 48% after standard-dose chemotherapy and surgery, if necessary. Two recent studies have showed that early high-dose chemotherapy (HDCT) with hematopoietic progenitor cell support (HPCS) may induce a 2-year overall survival rate of 78% in these patients. We report the long-term results of the experience at the Department of Oncology in Ravenna with early HDCT and HPCS in GCT patients with poor prognosis (IGCCCG criteria). Between 1987 and 2002, 18 poor prognosis GCT patients (17 M, one F), median age 24.5 years (range, 17-52), were treated with early HDCT with HPCS. In total, (67%) patients achieved a complete remission and they are continuously disease-free at a median follow-up of 9.2 years (range, 1.7-16.2). One treatment-related death occurred. No patient developed myelodysplasia or a secondary leukemia. This is notably the longest follow-up reported in patients having received HDCT in this setting. No patient achieving a complete remission relapsed. The role of HDCT in poor prognosis GCT will be defined from the ongoing phase III randomized trials.

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Section: Discussionsupporting

confidence: 87%

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Giorgi

Rosti

Papiani

et al. 2004

Bone Marrow Transplant

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“…Several authors report changes in cardiovascular status within years to decades after chemotherapeutic treatment for TC (Meinardi et al, 2000;Strumberg et al, 2002;Huddart et al, 2003;van den Belt-Dusebout et al, 2007), but little is known of the early changes in cardiac function in these patients. Regarding treatmentrelated cardiotoxicity from various cancer treatments, it was recently postulated that diastolic cardiac function deteriorates before the development of systolic dysfunction (Ewer and Lenihan, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…It can be hypothesised that the hearts of these relatively young patients can compensate for the chemotherapy-induced damage. On the contrary, they are at increased risk of developing an unfavourable cardiovascular-risk profile (Meinardi et al, 2000;Strumberg et al, 2002;Nuver et al, 2005c;Haugnes et al, 2007), which can contribute to the development of long-term cardiac failure.…”

Section: Cardiac Function After Chemotherapy For Testicular Cancermentioning

confidence: 99%

“…In the growing population of TC survivors, the occurrence of long-term treatment-induced organ damage is increasingly recognised as an important cause of morbidity (Feldman et al, 2008). Compared with the general population, long-term TC survivors have a higher incidence of second malignant neoplasms and cardiovascular disease (Meinardi et al, 2000;Strumberg et al, 2002;Huddart et al, 2003;van den Belt-Dusebout et al, 2007).…”

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confidence: 99%

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Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

et al. 2009

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Long-term cardiovascular morbidity is increasingly observed in chemotherapy-treated testicular cancer survivors, but little is known of early sub-clinical changes in cardiac function. We prospectively evaluated cardiac function in testicular cancer patients by echocardiography. Systolic (Wall Motion Score Index) and diastolic (E/A-ratio and Tissue Velocity Imaging (TVI)) parameters, and serum levels of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) were assessed before the start of chemotherapy and 1 year later. Echocardiography data were compared with an age-matched group of healthy controls. Forty-two patients treated with bleomycin, etoposide and cisplatin were evaluated (median age 27 years, range 18 -50). Systolic function and E/A-ratio did not change, whereas the median TVI decreased (12.0 vs 10.0 cm s À1 ; P ¼ 0.002). Median levels of NT-proBNP increased (5 vs 18 pmol l À1 , P ¼ 0.034). Compared with controls, TVI before the start of chemotherapy was not significantly different. In conclusion, we found that at a median of 10 months after cisplatin-based treatment for testicular cancer, TVI decreased significantly, indicating a deterioration of diastolic cardiac function. Serum levels of NT-proBNP increased. The prognostic significance of these changes for future cardiovascular morbidity is not clear.

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“…Germ-cell tumours are highly sensitive to cisplatinum-based chemotherapy, resulting in cure rates of over 90% for patients with minimal metastatic disease, and in 70 -80% of patients with metastatic disease Schmoll, 1999;Gerl, 2000). Since most of the patients are going to be long-term survivors with high life expectancy, long-term sequelae (Strumberg et al, 2002), side effects and secondary morbidities (Hartmann et al, , 2000, as well as psychosocial difficulties, sexual life problems and quality-of-life (QL) issues have become the major long-term complications of testicular cancer treatment. The diagnosis of germ-cell tumours often falls in a life-phase, when young adult men are usually in the prime of their physical health, starting their professional career, and are planning to have a family.…”

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confidence: 99%

Subjective quality of life and sexual functioning after germ-cell tumour therapy

et al. 2003

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Purpose: To evaluate the influence of germ-cell tumour therapy on sexual functioning and subjective quality of life (QL). To investigate the communication about sexual problems between patients, their partners, and doctors. In all, 474 patients treated for germ-cell tumours at the Department of Internal Medicine III, Ludwig-Maximilians-University Munich, from 1979 to 2000 were asked to complete a self-report questionnaire concerning psychosocial dimensions and subjective QL (QLS; Henrich and Herschbach, 2000). In total, 341 patients returned a completed questionnaire (response rate, 71.9%). The median age at survey was 41.9 years and the median follow-up period after therapy was 9.6 years. Persisting sexual sequelae were lower than in the current literature: decreased sexual desire (7.1%), erection (10.0%), orgasm (10.2%), ejaculation (28.8%), sexual activity (8.5%), and sexual satisfaction (4.8%). In QL the satisfaction with 'friends/acquaintances' (Po0.001) and 'family life/children' (Po0.001), is lower than in the healthy population. Correlations between functional scales and subjective QL were highly significant. There is a strong correlation between sexual satisfaction and global life satisfaction (Spearman's Rho: 0.48; Po0.01). A total of 61.4% of patients were not offered communication about sexual problems by their doctors and 21.2% were unable to talk with their partner about sexual issues. In conclusion, moderating psychosocial variables (e.g. personality factors, cognitive processes) should be investigated to clarify the relationship between life satisfaction (subjective QL) and functional impairments. Communication about sexual problems should be offered as a standard to patients treated for germ-cell tumours.

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

Abstract: 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.

Cited by 214 publications

References 37 publications

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

Subjective quality of life and sexual functioning after germ-cell tumour therapy

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