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Complications associated with chemotherapy in testicular cancer management

Abstract

Testicular cancer is the most common solid tumor among men aged 15–35 years. The introduction of cisplatin-based chemotherapy has resulted in a cure rate of over 95% for men with testicular cancer, which has put increased emphasis on understanding the morbidity associated with chemotherapy. Hematological, gastrointestinal, gonadal, otological, renal, neurological, and pulmonary toxicities are the most common acute adverse effects. Although most patients recover, some of these effects can persist after the chemotherapy regimen has been completed and can become chronic problems. The late complications associated with cisplatin-based chemotherapy include secondary malignancies, cardiovascular disease, avascular necrosis, and cognitive impairment. Late complications can have considerable effects on survival and quality of life, so close monitoring of patients is critical for the early diagnosis of late adverse effects and to limit associated damage. All patients should adopt a healthy lifestyle and follow age-appropriate cancer screening programs. Hormonal supplementation should be considered for those with a low testosterone level, in order to reduce the risk of sexual dysfunction and metabolic syndrome. Prompt diagnosis of avascular necrosis is essential, and it should be considered in the differential diagnosis for any long-term testicular cancer survivor complaining of hip pain. Finally, sperm cryopreservation should be discussed with all patients before chemotherapy is initiated.

Key Points

  • Treatment-related complications in testicular cancer patients are dependent on the cumulative dose of chemotherapy agents, particularly cisplatin; prevention of these effects is important as testicular cancer is highly curable and usually affects young men

  • Myelosuppression, nausea, vomiting, transient elevation in liver enzymes, and ifosfamide-induced encephalopathy are the most common acute chemotherapy-related adverse effects, which are not usually associated with long-term sequelae

  • Infertility, gonadal dysfunction, nephrotoxicity, ototoxicity, peripheral neuropathy, Raynaud phenomenon, and pulmonary disorders are acute effects that may persist after chemotherapy is discontinued

  • Late sequelae of chemotherapy, which can develop many years after treatment, include secondary malignancies, cardiovascular disease, avascular necrosis, and cognitive dysfunction

  • Despite these toxicities, both the substitution of cisplatin with carboplatin or the reduction or delay of the cisplatin dose are contraindicated in testicular cancer patients treated with curative intent

  • Close monitoring of patients after chemotherapy is critical for diagnosis, prevention, and treatment of late sequelae; patients should adopt a healthy lifestyle, follow cancer screening programs, and consider sperm cryopreservation before chemotherapy begins

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C. Fung researched data for, and wrote, the article. D. J. Vaughn and C. Fung made substantial contributions to dicussion of content and reviewed and edited the manuscript before submission.

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Fung, C., Vaughn, D. Complications associated with chemotherapy in testicular cancer management. Nat Rev Urol 8, 213–222 (2011). https://doi.org/10.1038/nrurol.2011.26

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