Treatment-Specific Risks of Second Malignancies and Cardiovascular Disease in 5-Year Survivors of Testicular Cancer

2007 ◽  
Vol 25 (28) ◽  
pp. 4370-4378 ◽  
Author(s):  
Alexandra W. van den Belt-Dusebout ◽  
Ronald de Wit ◽  
Jourik A. Gietema ◽  
Simon Horenblas ◽  
Marieke W.J. Louwman ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Cox Regression ◽  
Late Complication ◽  
Late Complications ◽  
Malignant Neoplasms ◽  
Second Malignancies ◽  
Similar Extent ◽  
Second Malignant Neoplasms

Purpose To compare radiotherapy and chemotherapy effects on long-term risks of second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) in testicular cancer (TC) survivors. Patients and Methods In our nationwide cohort comprising 2,707 5-year TC survivors, incidences of SMNs and CVDs were compared with general-population rates by calculating standardized incidence ratios (SIRs) and absolute excess risks (AERs). Treatment effects on risks of SMN and CVD were quantified in multivariable Cox regression and competing risks analyses. Results After a median follow-up time of 17.6 years, 270 TC survivors developed SMNs. The SIR of SMN overall was 1.7 (95% CI, 1.5 to 1.9), with an AER of 32.3 excess occurrences per 10,000 person-years. SMN risk was 2.6-fold (95% CI, 1.7- to 4.0-fold) increased after subdiaphragmatic radiotherapy and 2.1-fold (95% CI, 1.4- to 3.1-fold) increased after chemotherapy, compared with surgery only. Subdiaphragmatic radiotherapy increased the risk of a major late complication (SMN or CVD) 1.8-fold (95% CI, 1.3- to 2.4-fold), chemotherapy increased the risk of a major late complication 1.9-fold (95% CI, 1.4- to 2.5-fold), and smoking increased the risk of a major late complication 1.7-fold (95% CI, 1.4- to 2.1-fold), compared with surgery only. The median survival time was 1.4 years after SMN and 4.7 years after CVD. Conclusion Radiotherapy and chemotherapy increased the risk of developing SMN or CVD to a similar extent as smoking. Subdiaphragmatic radiotherapy strongly increases the risk of SMNs but not of CVD, whereas chemotherapy increases the risks of both SMNs and CVDs. Prolonged follow-up after chemotherapy is needed to reliably compare the late complications of radiotherapy and chemotherapy after 20 years.

scholarly journals Testicular Cancer Survivorship

2019 ◽  
Vol 17 (12) ◽  
pp. 1557-1568 ◽  
Author(s):  
Chunkit Fung ◽  
Paul C. Dinh ◽  
Sophie D. Fossa ◽  
Lois B. Travis
Keyword(s):  
Testicular Cancer ◽  
Cancer Survivorship ◽  
Relative Survival ◽  
Future Research ◽  
Malignant Neoplasms ◽  
Long Term Effects ◽  
Long Term Treatment ◽  
Second Malignant Neoplasms

Testicular cancer (TC) is the most common cancer among men aged 18 to 39 years. It is highly curable, with a 10-year relative survival approaching 95% due to effective cisplatin-based chemotherapy. Given the increasing incidence of TC and improved survival, TC survivors (TCS) now account for approximately 4% of all US male cancer survivors. They have also become a valuable cohort for adult-onset cancer survivorship research, given their prolonged survival. Commensurately, long-term treatment-related complications have emerged as important survivorship issues. These late effects include life-threatening conditions, such as second malignant neoplasms and cardiovascular disease. Moreover, TCS can also experience hearing loss, tinnitus, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, infertility, anxiety, depression, cognitive impairment, and chronic cancer-related fatigue. Characterization of the number and severity of long-term adverse health outcomes among TCS remains critical to develop risk-stratified, evidence-based follow-up guidelines and to inform the development of preventive measures and interventions. In addition, an improved understanding of the long-term effects of TC treatment on mortality due to noncancer causes and second malignant neoplasms remains paramount. Future research should focus on the continued development of large, well-characterized clinical cohorts of TCS for lifelong follow-up. These systematic, comprehensive approaches can provide the needed infrastructure for further investigation of long-term latency patterns of various medical and psychosocial morbidities and for more in-depth studies investigating associated etiopathogenetic pathways. Studies examining premature physiologic aging may also serve as new frontiers in TC survivorship research.

scholarly journals Risk of Second Malignant Neoplasms Among Long-term Survivors of Testicular Cancer

1997 ◽  
Vol 89 (19) ◽  
pp. 1429-1439 ◽  
Author(s):  
L. B. Travis ◽  
R. E. Curtis ◽  
J. F. Fraumeni ◽  
J. D. Boice ◽  
H. Storm ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Malignant Neoplasms ◽  
Second Malignant Neoplasms ◽  
Long Term Survivors

Solid organ second malignant neoplasms among children diagnosed with malignant bone tumors treated on Children Cancer Study Group/Pediatric Oncology Group protocols after 1980

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9007-9007
Author(s):  
R. Goldsby ◽  
C. Burke ◽  
R. Nagarajan ◽  
T. Zhou ◽  
Z. Chen ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Univariate Analysis ◽  
Primary Diagnosis ◽  
Malignant Neoplasms ◽  
Solid Organ ◽  
Malignant Bone Tumors ◽  
Entire Cohort ◽  
Second Malignant Neoplasms

9007 Background: The growing number of individuals surviving childhood cancer has increased the awareness and recognition of long-term sequelae. One of the most worrisome complications following cancer therapy is the development of second malignant neoplasms (SMN), in particular, late-occurring solid second malignancies related radiation therapy. Methods: We describe the incidence of solid organ SMN in survivors of pediatric malignant bone tumors (MBT) treated on legacy CCG/POG protocols from 1980 to 2005. This retrospective cohort study included 2,842 patients, 1,686 treated for osteosarcoma (OS) and 1,156 treated for Ewings Sarcoma (ES). The cohort included 56% males and 44% females, with a median age at primary diagnosis of 13 years. The median length of follow-up was 4.3 years (range: 0 to 20.9 years). Results: At the time of the analysis, 64% of patients in this study are alive. Seventeen patients with solid organ SMN were identified, and included three patients with breast cancer, three with malignant fibrous histiocytoma, two with osteosarcoma, and 9 patients with other solid organ malignancies. The standardized incidence ratio (SIR=observed/expected cases) was 2.9 (95% confidence interval [CI], 1.4–5.4) for patients treated for OS and 5.0 (95%CI 2.6–9.4) for patients treated for ES. The median time from diagnosis to develop solid organ SMN was 7 years (range: 1 to 13 years). The 10-year cumulative incidence of solid organ SMN for the entire cohort was 1% (95%CI 0.6–2%). In univariate analysis, treatment with etoposide, cyclophosphamide or radiotherapy were each associated with a higher than expected incidence of cancer with SIR of 4.8 (95% CI, 2.5–9.5), 5.8 (95% CI, 3.5–9.5) and 4.1 (95% CI, 2.4–7.1), respectively. Conclusions: Solid organ SMNs are rare after treatment for OS and ES, although higher in patients treated for ES. Recurrence remains the most significant problem for patients diagnosed with MBT and development of improved therapies with fewer long-term consequences remains paramount. However, solid organ cancers are likely to increase with longer follow-up. Therefore, surveillance should focus on monitoring for both recurrence of primary malignancies and development of SMN. No significant financial relationships to disclose.

Review of Late Complications of Treatment and Late Relapse in Testicular Cancer

2006 ◽  
Vol 4 (10) ◽  
pp. 1059-1070 ◽  
Author(s):  
Eleni Efstathiou ◽  
Christopher J. Logothetis
Keyword(s):  
Testicular Cancer ◽  
Tumor Biology ◽  
Late Complications ◽  
Treatment Modalities ◽  
Late Relapse ◽  
Second Malignancies ◽  
Cardiovascular Toxicity ◽  
Treatment Standards ◽  
The Metabolic Syndrome

With testicular cancer, a disease with a cure rate of 95%, the challenge is to restore quality of life to pretreatment levels and sustain it long-term. Although the implementation of guidelines and optimization of treatment modalities over the past years have served this purpose, some complications remain inevitable and experts are still challenged with late complications of outdated treatment standards. This article focuses on the late complications of cisplatin-based chemotherapy without disregarding those of currently applied infradiaphragmatic radiation. The most serious long-term complications of chemotherapy or radiotherapy are cardiovascular toxicity and second malignancies, as each has a 25-year risk of approximately 16%. Compared with the general population, risk for second malignancies remains significantly increased for at least 35 years after treatment. Chemotherapy-related cardiovascular toxicity is probably a result of both direct endothelial damage induced by cisplatin and indirect hormonal and metabolic changes. The increased incidence of the metabolic syndrome identified in long-term survivors is most likely associated with the lower testosterone levels reported. Cisplatin-based chemotherapy affects not only Leydig cells but also Sertoli and germ cells, resulting in infertility in 30% to 50% of testicular cancer patients treated with chemotherapy. Chronic neurotoxicity occurs in half of men, whereas permanent ototoxicity and some degree of renal function impairment occur in up to 30%. Pulmonary fibrosis, occurring in 5% to 10% of patients treated with bleomycin, is fatal in 1%. Although current treatment of advanced disease has changed its natural course, we are challenged by an increasing incidence of late relapse, an entity with a distinct tumor biology characterized by latency and chemoresistance.

Long-Term Follow up of Children with Apalstic Anemia Treated with Immunosuppressive Therapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 997-997
Author(s):  
Bunchoo Pongtanakul ◽  
Prabodh K. Das ◽  
Yigal Dror
Keyword(s):  
Partial Response ◽  
Immunosuppressive Therapy ◽  
Late Complication ◽  
Complete Response ◽  
Late Complications ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

Abstract Background: Immunosuppressive therapy (IST) is the alternative first line treatment in children with aplastic anemia (AA) who have no HLA match siblings available. The long-term outcome of patients with AA who survive after IST is unknown. We evaluated outcomes of children with AA treated with IST at long-term follow up. Methods: we retrospectively reviewed the hospital records of children with AA from 1984 to 2004, treated at our institution with horse-derived antithymocyte globulin (hATG) 160 mg/Kg over 4 days, short course of prednisone and cyclosporine (CS). Results: Forty two patients were treated with IST (25 boys, 18 girls). The median age at diagnosis was 8.5 years. Twenty nine (69%), eight (19%) and five (12%) patients were diagnosed with severe, very severe, and moderate AA, respectively. Nine patients (21%) had hepatitis associated AA. Twenty seven patients (64%) received one course of ATG and fifteen (36%) received 2 courses (8 received 2 courses of hATG and 7 received 1 course hATG and 1 course rabbit derived ATG). Eleven patients (26%) required G-CSF. Median follow up time was 53.3 months (range 3–244 months). Twenty six patients (62%) had a complete response (CR), eight (19%) had a partial response (PR) and eight (19%) had no response (NR). Two patients relapsed after one course of IST and needed a second course of IST and both of them had a partial response. Median time to discontinuation of CS was 13 months. Nine patients (21%) died (7 with NR and 2 with PR) and 33 patients (79%) are alive. Two patients developed myelodysplastic syndrome (MDS) 21 and 19 months post IST; both received long-term G-CSF (18 and 14 months) and had PR after 2 courses of IST. Five of 33 patients (15%) who survived had significant hypertension after CS was discontinued and one required continuous antihypertensive medication. Conclusion: The results of this study shows promising response in children with AA treated with IST. Hypertension and MDS are late complication. Longer follow up in these patients is warranted to definite the accurate rates of the late complications and risk factors.

Long-Term Risk of Cardiovascular Disease in 5-Year Survivors of Testicular Cancer

2006 ◽  
Vol 24 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Alexandra W. van den Belt-Dusebout ◽  
Janine Nuver ◽  
Ronald de Wit ◽  
Jourik A. Gietema ◽  
Wim W. ten Bokkel Huinink ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Testicular Cancer ◽  
Cox Regression ◽  
Myocardial Infarctions ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
Smoking Intervention ◽  
Cox Analysis

Purpose To evaluate the long-term risk of cardiovascular disease (CVD) in survivors of testicular cancer (TC). Patients and Methods We compared CVD incidence in 2,512 5-year survivors of TC, who were treated between 1965 and 1995, with general population rates. Treatment effects on CVD risk were quantified in multivariate Cox regression analysis. Results After a median follow-up of 18.4 years, 694 cardiovascular events occurred, including 141 acute myocardial infarctions (MIs). The standardized incidence ratio (SIR) for coronary heart disease was 1.17 (95% CI, 1.04 to 1.31), with 14 excess cases per 10,000 person-years. The SIR for MI was significantly increased in nonseminoma survivors with attained ages of less than 45 (SIR = 2.06) and 45 to 54 years (SIR = 1.86) but significantly decreased for survivors with attained ages of 55 years or older (SIR = 0.53). In Cox analysis, mediastinal irradiation was associated with a 3.7-fold (95% CI, 2.2- to 6.2-fold) increased MI risk compared with surgery alone, whereas infradiaphragmatic irradiation was not associated with an increased MI risk. Cisplatin, vinblastine, and bleomycin (PVB) chemotherapy (CT) was associated with a 1.9-fold (95% CI, 1.7- to 2.0-fold) increased MI risk, and bleomycin, etoposide, and cisplatin (BEP) CT was associated with a 1.5-fold (95% CI, 1.0- to 2.2-fold) increased CVD risk and was not associated with increased MI risk (hazard ratio = 1.2; 95% CI, 0.7 to 2.1). Recent smoking was associated with a 2.6-fold (95% CI, 1.8- to 3.9-fold) increased MI risk. Conclusion Nonseminomatous TC survivors experience a moderately increased MI risk at young ages. Physicians should be aware of excess CVD risk associated with mediastinal radiotherapy, PVB CT, and recent smoking. Intervention in modifiable cardiovascular risk factors is especially important in TC survivors. Whether BEP treatment increases CVD risk should be evaluated after more prolonged follow-up.

Detection of second malignancies during long-term follow-up of testicular cancer survivors

Cancer ◽  
2011 ◽  
Vol 117 (18) ◽  
pp. 4212-4218 ◽  
Author(s):  
Tomas Buchler ◽  
Petra Kubankova ◽  
Ludmila Boublikova ◽  
Zuzana Donatova ◽  
Martin Foldyna ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Cancer Survivors ◽  
Second Malignancies ◽  
Long Term Follow Up ◽  
Testicular Cancer Survivors

Long-Term and Late Effects of Germ Cell Testicular Cancer Treatment and Implications for Follow-Up

2012 ◽  
Vol 30 (30) ◽  
pp. 3752-3763 ◽  
Author(s):  
Hege S. Haugnes ◽  
George J. Bosl ◽  
Hink Boer ◽  
Jourik A. Gietema ◽  
Marianne Brydøy ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Late Effects ◽  
Current Status ◽  
Malignant Neoplasms ◽  
Treatment Type ◽  
Increased Risk

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.

Alternative pulmonary artery reconstruction technique in the arterial switch operation

2021 ◽  
Author(s):  
Hisayuki Hongu ◽  
Masaaki Yamagishi ◽  
Yoshinobu Maeda ◽  
Keiichi Itatani ◽  
Masatoshi Shimada ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Complication ◽  
Late Complications ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Arterial Switch ◽  
Switch Operation ◽  
Longitudinal Extension

Abstract OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.

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