Platinum exposure and cause‐specific mortality among patients with testicular cancer

Abstract

BACKGROUND: Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause-specific excess mortality has been rarely studied among patients treated in the platinum era. METHODS: In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, causespecific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis. RESULTS: With a median follow-up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%-10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft-tissue sarcomas, and leukemia; 1.9-fold increased mortality (95% CI, 1.3-2.8) from IHD; and 3.9-fold increased mortality (95% CI, 1.5-8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8-2.5) and 2.5 times higher SMN mortality (95% CI, 2.0-3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum-containing chemotherapy had a 2.5-fold increased hazard ratio (HR; 95% CI, 1.8-3.5) for SMN mortality in comparison with patients without platinum-containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19-0.39) per 100 mg/m 2 platinum dose administered (P trend < .001). IHD mortality was increased 2.1-fold (95% CI, 1.5-4.2) after platinum-containing chemotherapy in comparison with patients without platinum exposure. CONCLUSIONS: Platinum-containing chemotherapy is associated with a dosedependent increase in the risk of SMN mortality. Cancer 2020;126:628-639.

Patterns of Disease Progression and Outcome of Patients With Testicular Seminoma Who Relapse After Adjuvant or Curative Radiation Therapy

“…Among the 23 patients with CS II disease (ie, radiation therapy with curative intent), 18 (78%) patients had CS II at diagnosis, whereas 5 patients (22%) had metachronous relapses after active surveillance. Patients with CS I, IIA, and IIB received a median total radiation dose of 25 Gy (95% CI, 23-27), 32 Gy (95% CI, [30][31][32][33][34][35], and 36 Gy (95% CI, 31-37), respectively. Among 22 of the 23 CS II patients assessable for response, radiation therapy response categories were complete remission (CR), tumor-marker negative partial remission (PRm−), and progressive disease (PD) in 16 (73%), 3 (14%), and 3 (14%) cases, respectively.…”

Diagnostic yield of colonoscopy surveillance in testicular cancer survivors treated with platinum-based chemotherapy: study protocol of a prospective cross-sectional cohort study

“…In this model, the influence of the implementation of a surveillance program (colonoscopy or FIT) will be simulated. This model can estimate the incidence, prevalence and mortality of CRC, and the results and effects of surveillance based on the prevalence of advanced neoplasia detected during this current study and taking to account the mortality risk of TC survivors [ 30 ]. The costs and number of life-years gained for the population with and without the implementation of surveillance will be evaluated.…”

Management of stage I testicular cancer

“…Historically, an argument for the use of chemotherapy in this setting was to avoid the risk of secondary malignancy associated with irradiation. Recent data, though, has shown that cisplatin-based chemotherapy carry similar risks of secondary malignancy, as highlighted by Dutch and Norway population-based studies (2.5 and 2.0-3.7-fold increased risk observed, respectively) [19,20]. In addition, late chemotherapy-related toxicities must also be taken into account; including peripheral neuropathy, hearing loss, tinnitus, renal disease, and metabolic syndrome.…”