title: Retinal toxicity after cisplatin-based chemotherapy in patients with germ cell cancer.
abstract: OBJECTIVE
  Visual impairment represents an infrequent form of cisplatin-induced neurotoxicity; however, visual deterioration has been reported in several studies. To evaluate potential morphological and functional retinal alterations in patients with germ cell cancer (GCC) treated with cisplatin-based chemotherapy (CBC).
  
  
  METHODS
  Multi-disciplinary and multi-institutional study design. Examination of 28 eyes of 14 male GCC patients, who had received at least one cycle of CBC. A matched control group of healthy, untreated patients were included in this study. Subjects underwent a retinal nerve fiber thickness (RNFL) measurement, color vision, visual acuity testing, full-field electroretinograms (ff-ERG). To assess a correlation between cumulative cisplatin dose and measured RNFL and ff-ERG Pearson correlation coefficient analysis was performed.
  
  
  RESULTS
  Both study groups (CBC recipients vs. healthy controls) consisted each of 14 participants with a median patient age of 30 years (interquartile range (IQR) 26-37 years). Tumor histology was seminoma in 6 of 14 patients (43%), and non-seminomatous GCC in 8 of 14 patients (57%). Median cumulative cisplatin dosis at examination was 627 mg/m2(IQR 413-1013 mg/m2). Morphological assessment revealed reduced RNFL in 11 of 14 patients (78.6%). Reduction in RNFL was significantly correlated to the cumulative CBC dose received (rho = + 0.70; p = 0.004). ff-ERG showed significant differences between CBC recipients and the control group in 2 of 5 tested categories (all p values <0.001).
  
  
  CONCLUSIONS
  This study represents first evidence of chronic subclinical retinal toxicity due to cisplatin-based chemotherapy in patients with GCC. The reduction of RNFL might become clinically relevant in upcoming age-related chronic degenerative disorders such as glaucoma.
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Dulz
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Asselborn
authors.affiliation: Department of Urology, Albertinen Medical Center, Hamburg, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Dieckmann
authors.affiliation: Department of Urology, Military Army Medical Center, Hamburg, Germany.
authors.forename: Cord
authors.initials: C
authors.lastname: Matthies
authors.affiliation: Department of Urology, Military Army Medical Center, Hamburg, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Wagner
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Weidmann
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Seidel
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Oing
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lars A
authors.initials: LA
authors.lastname: Berger
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Alsdorf
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Blanche
authors.initials: B
authors.lastname: Mankichian
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Malte W
authors.initials: MW
authors.lastname: Vetterlein
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Gild
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Ludwig
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Soave
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schriefer
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.affiliation: Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.affiliation: Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Wagenfeld
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. L.Kluth@uke.de.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Kluth
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D004596:Electroretinography; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D010865:Pilot Projects; D012160:Retina / Q000187:drug effects* / Q000473:pathology; D013736:Testicular Neoplasms / Q000188:drug therapy*; D041623:Tomography, Optical Coherence
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Chemotherapy; Cisplatin; Germ cell cancer; Late effects; Retinal toxicity; Testicular cancer