The course of long-term toxicity in patients treated with cisplatin-based chemotherapy for non-seminomatous germ-cell cancer.
BACKGROUND
The prognosis of advanced testicular cancer has improved considerably after the introduction of cisplatin-based combination chemotherapy. The improved prognosis of testicular cancer has brought the long-term toxicity of the treatment into focus.


METHODS
Long-term toxicity was investigated prospectively until more than 10 years after after treatment in a group of 22 patients treated with six series of cisplatin based chemotherapy (PVB) for testicular cancer. We have focused on nephro-, neuro-, pulmonary-, and gonadal toxicity.


RESULTS
Glomerular filtration rate (GFR) decreased significantly during treatment but increased during follow-up and all the patients had normal values of GFR 10-15 years after treatment. Carbon monoxide diffusion capacity (TLco) decreased during PVB treatment in smokers. TLco remained unchanged during the first years after PVB treatment, but improvement of TLco was seen in some patients more than 43 months after treatment. Paresthesia was reported by 83% of the patients immediately after treatment, 50% at follow-up 4-9 years after chemotherapy and 14% prevalence 11-15 hears after treatment. The reported decline in neurotoxicity was verified by normalisation of vibration perception. Gonadal toxicity was severe and persistent although improvement was seen in a few patients even many years after treatment.


CONCLUSIONS
The patients treated with PVB were physically and socially well-being at follow-up investigation 11-15 years after treatment. Improvements in pulmonary- and renal function, and recovery from neurotoxicity was seen during the long-term follow-up period. Gonadal toxicity was severe and persistent.
Petersen
P M
PM
Department of Oncology, Finsencenter, Copenhagen University Hospital, Rigshospitalet, Denmark.
Hansen
S W
SW
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001761:Bleomycin / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007246:Infertility / Q000139:chemically induced; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy*; D011653:Pulmonary Diffusing Capacity / Q000187:drug effects; D013076:Sperm Count / Q000187:drug effects; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy*; D013739:Testosterone / Q000097:blood; D014747:Vinblastine / Q000009:adverse effects
D001761:Bleomycin; D013739:Testosterone; D014747:Vinblastine; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D002945:Cisplatin