Gerson R, Serrano A, Villalobos A

Language: Spanish
References: 28
Page: 16-21
PDF size: 60.12 Kb.

ABSTRACT

Background. Testicular cancer constitutes 1.8% of all oncological cases in Mexico registered between 1993 and 1996. Life expectancy when patients are treated even with advanced disease is highly encouraging. Survivors can encounter with different complications due to neuro, nephro and ototoxicity, infertility and development of second malignancies. Objective. Long term evaluation and analysis of testicular cancer survivors. Method. Retrospective analysis of patients treated from 1984 to 1998. Age, tumor type, clinical state, metastatic sites, chemotherapy regimen utilized, number of Cycles, follow-up, and time and site of recurrence, health status, fatherhood after chemotherapy, hearing capacity, renal and hematological functions. Results. Twenty six males, average 27.7 ± years, follow-up 56.6 ± 38.7, range 1 to 149 months. Germinal nonseminomatous tumor was predominant in 22 patients (84.6%); clinical stage I, 12 (46.1%); II, 5 (19.2%) and III, 7 (27%) and 2 patients unclassified (7.7%). When diagnosed, 11 patients had localized disease (42.3%); 8 had one metastatic site; 5 had 2 to 3 and in 2 cases 4 or more metastatic sites. Average metastatic site 1.8 ± 1, range 1 to 4. Twenty one patients (80.7%) received chemotherapy, 15 with BEP, 5 CISCA II/VBIV and one case cytoxan-carboplatin. Average number of cycles 4.3 ± 1.9, range 1 to 11. One patient received adjuvant radiotherapy and 4 cases underwent surveillance. No deaths reported; 4 recurrences (15.4%), mean time of recurrence 13.5, range 1 to 144 months. Three in retroperitoneal nodes, one in CNS. No neurologic, auditory renal or hematologic abnormalities at follow-up detected. Nine patients achieved fatherhood after chemotherapy (34.6%), 4 more (15.3%) did nor plan more offspring; 2 are infertile and 11 single men at this time, are not considering paternity yet. Conclusions. With current therapies, patients with testicular cancer show good prognosis even at advanced stages. Secondary long term effects arising from treatment are minimal; though infertility has been recognized. Cryopreservation is suggested. It should be mandatory to evaluate the patient in an integral way before and after chemotherapy and monitor them closly in order to achieve an optimum quality of life level in cancer survivors.

REFERENCES

1. Dirección General de Epidemiología. Registro Histopatológico de Neoplasias. México: Secretaría de Salud, 1996; 25-26, 49-50.

2. Bosl GJ, Bajorin DF, Sheinfeld J et al. Cancer of the testis. In: De Vita VT, Hellman S, Rosemberg SA (eds). Cancer principles and practice of oncology. 5th ed. Philadelphia: Lippincott-Raven Publishers, 1997: 1397-1425.

3. International Germ Cell Cancer Collaborative Group: International Germ Cell Consensus Classification: A prognostic factor-based on system for metastatic germ cell cancers. J Clin Oncol 1997; (2): 594-603.

4. Gerson R, García-Irigoyen C, García-González H et al. Quimioterapia en cáncer testicular de alto riesgo. Experiencia del grupo uro-oncológico del Hospital General de México. Rev Med Hosp Gral Mex 1993; 56: 66-74.

5. Gerson R, Téllez-Bernal E, Lázaro M et al. Low toxicity with continuous infusion of bleomycin in poor prognostic testicular cancer. Am J Clin Oncol (CCT) 1993; 16: 323-326.

6. Osterlin A, Berthelsen JG, Abildgaard N et al. Risk of bilateral testicular germ cell cancer in Denmark: 1960-1984. J Natl Cancer Inst 1991; 83: 1391-1395.

7. Hansen PV, Trykker H, Helkjoer PE et al. Testicular function in patients with testicular cancer treated with orchiectomy alone or orchiectomy plus cisplatin based chemotherapy. J Natl Cancer Inst 1989; 81: 1246-1250.

8. Travis LB, Curtis RE, Storm H et al. Risk of second malignant neoplasms among long term survivors of testicular cancer. J Natl Cancer Inst 1997; 89: 1429-1439.

9. Osanto S, Bukman A, Van Hoek F et al. Long term effects of chemotherapy in patients with testicular cancer. J Clin Oncol 1992; 10: 574-579.

10. Robinson LL. Issues in the consideration of intervention strategies in long term survivors of childhood cancer. Cancer 1993; 71: 3406-3410.

11. Ferrel BR, Dow KH. Quality of life among long term cancer survivors. Oncology 1997; 11: 565-571.

12. Duchesne GM, Horwich A, Dearnaley DP et al. Orchiectomy alone for stage I seminoma of the testis. Cancer 1990; 65: 1115-1118.

13. Huddart SN, Mann JR, Gornall P et al. The UK Childrens cancer study group: testicular malignant germ cell tumors 1979-1988. J Pediatrics Surg 1990; 25: 1139-1143.

14. Friedman EL, Garnick MB, Stomper PC et al. Therapeutic guidelines and results in advanced seminoma. J Clin Oncol 1985; 3: 1325-1332.

15. Lange PH, Narayan P, Fraley EE. Fertility issues following therapy for testicular cancer. Sem Oncol 1984; 2: 264-274.

16. Ball ED, Barrett A, Peckham MJ. The management of metastatic seminoma testes. Cancer 1982; 50: 2289-2294.

17. Williams SD, Birch R, Einhorn LH et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin and either vinblastine or etoposide. N Engl J Med 1987; 316: 1435-1440.

18. Thompson SW, Davis LE, Kornfeld M et al. Cisplatin neuropathy. Clinical, electrophysiologic, morphologic and toxicologic studies. Cancer 1984; 54: 1269-1275.

19. Blachey JD, Hill JB. Renal and electrolyte disturbances associated with cisplatin. Ann Intern Med 1981; 95: 628-632.

20. Serrano A, Gerson R, Villela L et al. Comportamiento del magnesio sérico y urinario en pacientes tratados con cisplatino. An Med Asoc Med Hosp ABC 1995; 40 (4): 145-151.

21. Raghavan D, Cox K, Childs A et al. Hypercholesterolemia after chemotherapy for testis cancer. J Clin Oncol 1992; 10: 1386-1389.

22. Bosl GJ, Leitner SP, Atlas SA et al. Increase plasma renin and aldosterone in patients treated with cisplatin-based chemotherapy for metastatic germ cell tumors. J Clin Oncol 1986; 4: 1684-1689.

23. Gerson R, Serrano A, Díaz V et al. Modificaciones en la tensión arterial con cisplatino. Rev Med Hosp Gral Mex 1998; 6: 151-155.

24. Arai Y, Kawakita M, Okada Y et al. Sexuality and fertility in long term survivors of testicular cancer. J Clin Oncol 1997; 15: 1444-1448.

25. Hansen SW, Berthelsen JG, Von Der Maase H. Long term fertility and Leydig cell function in patients treated for germ cell cancer with cisplatin, vinblastine and bleomycin vs surveillance. J Clin Oncol 1990; 8: 1695-1698.

26. Rieker PP, Fitzgerald EM, Kalish LA. Adaptative behavioral responses to potential infertility among survivors of testis cancer. J Clin Oncol 1990; 8: 347-355.

27. Lange PH, Narayan P, Vogelzang NJ et al. Return of fertility after treatment for nonseminomatous testicular cancer: changing concepts. J Urol 1983; 129: 1131-1135.

28. Lampe H, Horwich A, Nicholls J et al. Fertility after chemotherapy for testicular germ cell cancer. J Clin Oncol 1997; 15: 239-245.