Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors

Abstract

Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.

Figure 1

Risk factors for second primary cancer (refer to text). Many influences some of which are diagrammed here may contribute to the development of multiple primary cancers, including interactions between exposures. ^∗Adapted with permission from Travis [169].

Figure 2

Proportion of testicular cancer survivors (TCS) with excellent, very good, good, fair, and poor self-reported health by number of adverse health outcomes (AHOs). P value for association of number of AHOs with self-reported health was <0.01 (Mantel 1 df chi-square test of trend). Self-reported health was not indicated by one participant with 1-2 AHOs and one participant with 3-4 AHOs. ^∗Adapted with permission from Fung et al. [40] (Figure 1).