Prediction of long-term gonadal toxicity after standard treatment for testicular cancer

Aass, Nina; Fosså, Sophie D.; Theodorsen, L.; Norman, Nils

doi:10.1016/0277-5379(91)90298-r

Cited by 62 publications

(38 citation statements)

References 25 publications

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“…There are only limited published data on the hormonal function of patients after orchidectomy alone (summarised in Table 7). The two largest previous studies reported findings similar to ours with subnormal testosterone in 5% (Gerl et al, 2001) and 16% (Aass et al, 1991) of patients. The deleterious effects of low testosterone are well recognised in a number of patient groups including patients receiving hormone therapy for prostate cancer (Bates et al, 1996;Simon et al, 1997;Smith et al, 2001).…”

Section: Discussionsupporting

confidence: 89%

“…In this study we have not undertaken analysis of spermatogenesis, but a number of studies (Fosså et al, 1985;Kreuser et al, 1989;Aass et al, 1991;Brennemann et al, 1998;Jacobsen et al, 2001) have emphasised the close correlation between FSH levels and sperm counts. On this basis the elevated level of FSH would suggest that there is a significant long-term impairment of spermatogenesis.…”

Section: Discussionmentioning

confidence: 99%

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Fertility, gonadal and sexual function in survivors of testicular cancer

et al. 2005

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Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n ¼ 169), with chemotherapy (C, n ¼ 272), radiotherapy (R, n ¼ 158), or both chemotherapy and radiotherapy (C/RT n ¼ 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (o10 nmol l À1 ) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P ¼ 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both Po0.005) and LH abnormalities after radiotherapy (11% Po0.01) and chemotherapy (10%, Po0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3 -9.25) iu l À1 compared to 3 (IQR 1 -5) iu l À1 for S; Po0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (À2 (IQR À8.0 to À1.5) vs 1.0. (IQR À4.0 -4.0) Po0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P ¼ 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% Po0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors. Testicular cancer is the most common cancer of young men in their 20s and 30s. Since the advent of effective multiagent cisplatinu...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Fertility, gonadal and sexual function in survivors of testicular cancer

et al. 2005

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“…Irradiation may cause small vessels disease and peripheral neuropathy resulting in erectile dysfunction (Fossa et al, 1980;von Eschenbach, 1980;Tomic et al, 1983;Goldstein et al, 1984;Fossa et al, 1986). The possible organic-biologic effects of chemotherapy itself are also complex, including temporary reduction of testosterone levels, hyperprolactinaemia, induction of vascular damage and peripheral neuropathy (El-Beheiry et al, 1988;Aass et al, 1991;van Basten et al, 1997a). Retroperitoneal lymph node dissection (RPLND) may cause permanent dry ejaculation due to the surgical interruption of retroperitoneal sympathetic nerves (Drasga et al, 1983).…”

mentioning

confidence: 99%

“…However, no strong correlation was demonstrable between testosterone serum concentration and erection (Buena et al, 1993;van Basten et al, 1995). Leydig cell function as well as testosterone production can be affected by radio-and chemotherapy (von Eschenbach, 1980;Aass et al, 1991). Irradiation may cause small vessels disease and peripheral neuropathy resulting in erectile dysfunction (Fossa et al, 1980;von Eschenbach, 1980;Tomic et al, 1983;Goldstein et al, 1984;Fossa et al, 1986).…”

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confidence: 99%

Long-term effects on sexual function and fertility after treatment of testicular cancer

et al. 1999

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Summary This retrospective study evaluates the types and incidences of sexual disturbances and fertility distress in patients cured from testicular cancer and examines whether there is an effect resulting from different treatment modalities. A self-reported questionnaire was sent to 124 randomly selected patients who were treated at Hanover University Medical School between 1970 and 1993. Ninety-eight patients were included in the study, representing a response rate of 78%. All patients had been in complete remission (CR) for at least 24 months. The median age at diagnosis was 28 years (range 17-44). The median follow-up at the time of study was 12.0 years (range 2.8-25.6). Twenty patients (20%) had been treated for seminomatous and 78 patients (80%) for non-seminomatous germ cell tumours. Treatment included surveillance (7%), primary retroperitoneal lymph node dissection (RPLND) (13%), chemotherapy (CT) (33%), CT + secondary resection of residual retroperitoneal tumour mass (SRRTM) (43%) and infradiaphragmatic radiotherapy (4%). Patients receiving two treatment modalities (CT+SRRTM) reported more frequent an unfulfilled wish for children. Inability of ejaculation was clearly associated with RPLND and SRRTM. Subjective aspects of sexuality, like loss of sexual drive and reduced erectile potential, occurred only in a minority of patients after treatment. No abnormalities were observed concerning the course of pregnancies of partners. In conclusion, sexual dysfunction and infertility are common long-lasting sequelae in testicular cancer survivors affecting approximately 20% of patients. The relative risk for infertility appeared to be elevated for patients treated with the combination of CT+SRRTM. Twenty-one of 40 patients were able to fulfil their wish for children, and no congenital abnormalities were observed in these children.

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“…From 1978 and the early 1980s, induction chemotherapy consisted of 4-6 cycles with the PVB regimen (cisplatin, vinblastine, bleomycin) (Narayan et al, 1982;Fosså et al, 1988;Aass et al, 1991). A few patients from 1980 to 1981 also received adriamycin as a component of consolidation treatment.…”

Section: Chemotherapymentioning

confidence: 99%

Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection

et al. 1999

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SummaryThe purpose of this study was to evaluate fertility after different types of post-chemotherapy retroperitoneal lymph node dissection (RPLND). During 1980During -1994 patients with metastatic testicular cancer underwent post-chemotherapy RPLND with a gradual shift from modified bilateral template RPLND to nerve-sparing RPLND. Modified bilateral template RPLND was done in 92% of the patients operated during 1980-1984 as compared to 16% during 1989-1994. Pre-and post-treatment fertility was assessed by microscopic sperm analysis, determination of serum FSH and information on ejaculation and paternity. There was no significant difference of the survival rates between the three treatment periods. Antegrade ejaculation was preserved in 11% of the patients after modified bilateral template RPLND as compared to 89% after the nerve-sparing operation technique. The median ejaculatory volume decreased post-operatively, serum FSH increased and sperm density remained unchanged. Fifty-six patients attempted fatherhood after their treatment, and 27 fathered at least one child after an observation-time of 55 months, nine of them by assisted fertilization. Patients with initially advanced testicular cancer but limited residual retroperitoneal masses after induction chemotherapy can safely undergo limited post-chemotherapy RPLND as a part of multimodality treatment. After nerve-sparing RPLND antegrade ejaculation is preserved in 89% of the patients though the ejaculatory volume decreases after RPLND. Post-treatment fatherhood can be achieved in at least 50% of the patients attempting paternity.

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Prediction of long-term gonadal toxicity after standard treatment for testicular cancer

Cited by 62 publications

References 25 publications

Fertility, gonadal and sexual function in survivors of testicular cancer

Fertility, gonadal and sexual function in survivors of testicular cancer

Long-term effects on sexual function and fertility after treatment of testicular cancer

Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection

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