Long-Term Risk of Cardiovascular Disease in 5-Year Survivors of Testicular Cancer

Belt-Dusebout, Alexandra W. van den; Nuver, Janine; Wit, Ronald de; Gietema, Jourik A.; Huinink, W.W. ten Bokkel; Rodrigus, P.; Schimmel, Erik C.; Aleman, Berthe M.P.; Leeuwen, Flora E. van

doi:10.1200/jco.2005.02.7193

Cited by 308 publications

(171 citation statements)

References 43 publications

(2 reference statements)

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“…For example, large clinical cohort studies have assessed the risk of cardiovascular disease in 5-year survivors treated for testicular cancer between 1965-1995 using chemotherapy and radiotherapy compared with surgical strategies. Non-surgical patients had an up to 2-fold increased risk of myocardial infarction compared to the surgical cohort [32]. Although the cellular effects of these treatments could not be assessed, it was proposed that long-term exposure of the endothelium to circulating platinum, and lowered testosterone levels may have been instrumental in the development of metabolic syndrome and associated cardiovascular disease.…”

Section: Cytotoxic Agents and Radiotherapymentioning

confidence: 99%

Role of DNA damage in atherosclerosis—Bystander or participant?

Gray

Bennett

2011

Biochemical Pharmacology

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Section: Cytotoxic Agents and Radiotherapymentioning

confidence: 99%

Role of DNA damage in atherosclerosis—Bystander or participant?

Gray

Bennett

2011

Biochemical Pharmacology

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“…The tendency to affect women in high estrogenic states suggests that the hormonal and thrombogenic status of the patient may play etiological roles in SCAD. Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.…”

mentioning

confidence: 73%

“…It is interesting to speculate as to the mechanism of myocardial infarction (MI) in a 24-year-old man. Testicular cancer patients are at increased risk of myocardial ischemia and infarction, particularly in the context of chemotherapy (3). Cisplatin has been implicated in ischemic events occurring during or shortly after completion of bleomycinetoposide-cisplatin therapy, even when other coronary risk factors are lacking (3).…”

Section: Discussionmentioning

confidence: 99%

“…Testicular cancer patients are at increased risk of myocardial ischemia and infarction, particularly in the context of chemotherapy (3). Cisplatin has been implicated in ischemic events occurring during or shortly after completion of bleomycinetoposide-cisplatin therapy, even when other coronary risk factors are lacking (3). Mechanisms of cisplatin-related MI include diffuse coronary vasospasm, fibrous intimal proliferation and perturbations of the clotting system (3).…”

Section: Discussionmentioning

confidence: 99%

“…SCAD involves hemorrhagic separation of the media, resulting in a false lumen that may heal spontaneously or occlude the true lumen, resulting in distal ischemia (3). Some may occlude, some may thrombose the false lumen, and a few will re-endothelialize and become chronic, with two lumens.…”

Section: Discussionmentioning

confidence: 99%

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An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Ghosh

Chow

Korley

et al. 2008

Canadian Journal of Cardiology

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S pontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia (1). It is more common in younger patients and in women, and has a propensity to affect patients without traditional cardiovascular risk factors (2). The tendency to affect women in high estrogenic states suggests that the hormonal and thrombogenic status of the patient may play etiological roles in SCAD. Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection. The long-term outcome of the dissection that persists is less well described (9,10).We report a case of chronic coronary artery dissection that had its onset during a course of bleomycin-etoposide-cisplatin therapy for testicular cancer. The implications of testicular cancer and chemotherapy, and the significance of chronic coronary artery dissection persistent on angiography will be discussed. CASE PRESENTATIONA 36-year-old man presented with a history of lightheadedness, shortness of breath and left-sided chest tightness after several minutes of playing hockey. Emergency medical services arrived at the scene and found the patient in monomorphic ventricular tachycardia at approximately 300 beats/min (Figure 1). The patient underwent electrical cardioversion, with almost immediate resolution of his symptoms. On admission to a local hospital, his troponin I peaked at 0.6 μg/L (10 times the upper limit of normal), and his electrocardiogram (ECG) showed significant Q waves in leads II, III and AVF, as well as ST depression in the inferolateral leads. The Q waves in the inferior leads were unchanged from previous ECGs recorded since July 1994. At the time of the current presentation, the patient was taking ramipril and Lipitor (Pfizer, Canada). He did not smoke and rarely used alcohol. He was started on acetylsalicylic acid, clopidogrel, enoxaparin and metoprolol by the referring centre, and was transferred to a tertiary care centre for further investigation.His medical history was relevant. At the age of 24 years he developed testicular cancer, which was treated with four cycles of chemotherapy following orchiectomy. During his last course of bleomycin-etoposide-cisplatin chemotherapy, the patient developed left chest, neck and shoulder discomfort, and presented to the hospital 12 h later. Serial ECGs revealed the development of a Q wave inferior infarction and poor R wave progression across precordial leads on serial tracings. He did not receive thrombolysis, and cardiac catheterization was not performed. He was sent home on acetylsalic...

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Medical Treatment of Advanced Testicular Cancer

Feldman

Bosl²,

Sheinfeld³

et al. 2008

JAMA

332

225

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ESTICULAR CANCER IS THE MOST common cancer diagnosis in men between the ages of 15 and 35 years, with approximately 8000 cases detected in the United States annually. 1 The majority (95%) of testicular neoplasms are germ cell tumors (GCTs), with other testicular neoplasms (ie, sex-cord stromal tumors, lymphomas) occurring more rarely. Germ cell tumors may also arise in extragonadal locations, such as the mediastinum and retroperitoneum.Remarkable progress has been made in the medical treatment of advanced testicular cancer with a substantial increase in cure rates from approximately 25% in the mid-1970s to nearly 80% today. 2 This cure rate is the highest of any solid tumor and improved survival is primarily due to effective chemotherapy. 3 It is important for all physicians to be familiar with this malignancy, because patients may initially present to a variety of practitioners, and delays in therapy are associated with more extensive disease resulting in more intensive treatment and lower cure rates. 4 In addition, the immediate and longterm toxic effects of treatment often require management from physicians of various disciplines. This article reviews the current evidence-based treatments for advanced testicular GCT, and the acute and chronic toxic effects that may result. The management of early stage (I-IIA) testicular cancers has been reviewed elsewhere. [5][6][7] BACKGROUND GCT Histology and GeneticsGerm cell tumors are malignancies of primordial germ cells, the cells destined to become spermatozoa. With neoplastic transformation, these cells take on a variety of histologies, reflect-See also Patient Page. CME available online at www.jamaarchivescme.com and questions on p 706.

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Long-Term Risk of Cardiovascular Disease in 5-Year Survivors of Testicular Cancer

Cited by 308 publications

References 43 publications

Role of DNA damage in atherosclerosis—Bystander or participant?

Role of DNA damage in atherosclerosis—Bystander or participant?

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Medical Treatment of Advanced Testicular Cancer

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