Pulmonary function in long-term survivors of testicular cancer.
OBJECTIVE
Long-term toxicity after cancer treatment has gained increasing clinical attention. We evaluated pulmonary function in long-term survivors of testicular cancer (TC).


METHODS
The pulmonary function of 1,049 TC survivors treated during 1980 to 1994 at three university hospitals in Norway was assessed by spirometry and a questionnaire (1998 to 2002). The patients were categorized into five treatment groups, as follows: surgery only (n = 202); radiotherapy only (n = 449); chemotherapy (cisplatin < or = 850 mg; n = 306); chemotherapy (cisplatin > 850 mg [higher-dose group]; n = 62); and chemotherapy and pulmonary surgery (cis/pulmsurg; n = 30). Spirometry variables included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Actual values and percentages of predicted normal values (FVC%pred and FEV1%pred, respectively) are reported. Restrictive lung disease was defined as FEV1/FVC > or = 70% and FVC%pred less than 80%.


RESULTS
Median observation time was 11.2 years (range, 5 to 21 years). Compared with the surgery group, the higher-dose or cis/pulmsurg groups had considerably lower age-adjusted FVC (higher-dose: beta = -.37; P = .001; cis/pulmsurg: beta = -.58; P < .001), FEV1 (higher-dose: beta = -.24; P = .014; cis/pulmsurg: beta = -.55; P < .001), FVC%pred (higher-dose: beta = -8.3; cis/pulmsurg: beta = -10.5; bothP < .001), and FEV1%pred (higher-dose: beta = -6.8; P = .003; cis/pulmsurg: beta = -12.4; P < .001). Adjustment for total testosterone, body mass index, smoking, and physical activity did not change these associations. Eight percent of all patients had restrictive lung disease, and the highest prevalence was in the higher-dose group (17.7%) and the cis/pulmsurg (16.7%) group. Compared with patients who underwent surgery only, these groups had odds ratio for restrictive disease of 3.1 (95% CI, 1.3 to 7.3) and 2.5 (95% CI, 0.8 to 7.6), respectively.


CONCLUSIONS
Large doses of cisplatin-based chemotherapy and combined chemotherapy/pulmonary surgery are significantly associated with decreased pulmonary function several years after TC treatment.
Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø N-9037, Norway. hege.sagstuen.haugnes@uit.no
Hege S
HS
Haugnes
Nina
N
Aass
Sophie D
SD
Fosså
Olav
O
Dahl
Marianne
M
Brydøy
Ulf
U
Aasebø
Tom
T
Wilsgaard
Roy M
RM
Bremnes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008175:Lung Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017741:Survivors; D013736:Testicular Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D055815:Young Adult