title: Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up.
abstract: Germ cell testicular cancer (TC) represents a malignancy with high cure rates. Since the introduction of cisplatin-based chemotherapy in the late 1970s, the 5-year survival rate has increased considerably, and it is currently above 95%. Because TC is usually diagnosed before the age of 40 years, these men can expect to live for another 40 to 50 years after being successfully treated. This success, however, is hampered by an increased risk of long-term and late effects of treatment. Secondary malignant neoplasms and cardiovascular disease represent the most common potentially life-threatening late effects, typically occurring more than 10 years after treatment. Other long-term effects include pulmonary toxicity, nephrotoxicity, neurotoxicity, decreased fertility, hypogonadism, and psychosocial problems. The incidence and time to onset of these various adverse effects vary according to treatment type and intensity. There is still little knowledge about underlying mechanisms and genetic susceptibility of the various adverse effects. Apart from treatment burden, it is not yet possible to identify patients who are at high risk for certain late effects after TC treatment. In this clinical review, we present the current status regarding different somatic and psychosocial long-term late effects after treatment for TC, based on Medline searches and our own research. Moreover, we postulate recommendations for general medical evaluations that should begin after treatment is completed and continue during follow-up.
authors.affiliation: Oncology Department, University Hospital of North Norway, Tromsø, Norway. hege.sagstuen.haugnes@uit.no
authors.forename: Hege S
authors.initials: HS
authors.lastname: Haugnes
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Hink
authors.initials: H
authors.lastname: Boer
authors.forename: Jourik A
authors.initials: JA
authors.lastname: Gietema
authors.forename: Marianne
authors.initials: M
authors.lastname: Brydøy
authors.forename: Jan
authors.initials: J
authors.lastname: Oldenburg
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology; D006801:Humans; D008019:Life Style; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors; D013736:Testicular Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents