Treatment-related cardiovascular late effects and exercise training countermeasures in testicular germ cell cancer survivorship.
BACKGROUND
Treatment of testicular germ cell cancer constitutes a major success story in modern oncology. Today, the vast majority of patients are cured by a therapeutic strategy using one or more highly effective components including surgery (orchiectomy), radiotherapy and/or chemotherapy. However, the excellent cancer-specific survival comes at considerable costs, as individuals with a history of germ cell cancer experience serious long-term complications, including markedly increased risk of cardiovascular morbidities and premature cardiovascular death. The factors responsible, as well as their mode of action, are not fully understood and there is a lack of knowledge concerning optimal evidence-based long-term follow-up strategies.


RESULTS
Here, we present the growing body of evidence suggesting that germ cell cancer patients as a consequence of the different treatment components, are subjected to toxicities, which individually, and synergistically, can cause physiological impairments leading to sub-clinical or clinical cardiovascular disorders (i.e. the 'multiple-hit hypothesis'). Furthermore, we discuss the efficacy and utility of structured exercise training to ameliorate treatment-induced cardiovascular dysfunction to prevent premature onset of clinical cardiovascular disease in germ cell cancer survivors, with a view towards highlighting future directions of exercise-based survivorship research in the germ cell cancer setting.


CONCLUSIONS
As exercise training may have the potential to ameliorate and/or reverse long-term cardiovascular disease sequelae in germ cell cancer survivors, a strong rationale exists for the promotion of exercise oncology research in this setting, in order to provide exercise recommendations for optimal germ cell cancer survivorship.
The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen , Denmark.
Jesper F
JF
Christensen
Mikkel
M
Bandak
Anna
A
Campbell
Lee W
LW
Jones
Pernille
P
Højman
D000222:Adaptation, Physiological; D000932:Antiemetics / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D002320:Cardiovascular Physiological Phenomena; D015444:Exercise / Q000502:physiology*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D009919:Orchiectomy / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D055070:Resistance Training / Q000379:methods*; D017741:Survivors; D013736:Testicular Neoplasms / Q000628:therapy*; D055815:Young Adult
D000932:Antiemetics; D000970:Antineoplastic Agents; D005938:Glucocorticoids