Testicular cancer is the most common solid tumour among young males aged 15-35 years.
Cisplatin-based
combination chemotherapy has changed the outlook of this disease. Disseminated
testicular cancer, once uniformly fatal, now has a cure rate of more than 80% with
combination chemotherapy. Systematic randomised trials have shown that
cisplatin,
etoposide and
bleomycin (PEB)
combination chemotherapy remains the mainstay of treatment. While there is a high cure rate with
chemotherapy in patients with this disease, some long-term complications from
chemotherapy have now been recognised, including secondary leukaemia,
therapy-related solid tumours, nephrotoxicity, neurotoxicity, pulmonary toxicity, vascular toxicity and
infertility.
Etoposide,
a DNA topoisomerase II inhibitor, is a significant risk factor for developing leukaemia; the risk appears to be correlated with the total dose given. Patients receiving
cisplatin-based
combination chemotherapy for
testicular cancer also appear to have a higher relative risk for developing second non-germ cell
malignancies; the greatest risks for
therapy-related solid tumours were seen with a combination of
radiation therapy plus
chemotherapy. Long-term vascular toxicities associated with
chemotherapy include Raynaud's phenomenon, acute
myocardial infarction and cerebrovascular events.
Bleomycin is thought to be the most important
drug in the pathogenesis of Raynaud's phenomenon, while
cisplatin is the most likely agent involved in
myocardial infarction.
Peripheral neuropathy is the most common form of neurotoxicity observed with
cisplatin-based
chemotherapy. Risk factors for the development of neural damage include a high cumulative dose of
cisplatin, the use of
vinblastine and the concomitant development of Raynaud's phenomenon.
Cisplatin is also well known to cause significant nephrotoxicity. Approximately 25% of patients present with
azoospermia after undergoing
combination chemotherapy with a follow up of 2-5 years. Physician awareness of complications associated with
chemotherapy is vital to maximise efficacy, minimise toxicity, and preserve quality of life
after treatment. Sperm cryopreservation should be considered for patients who desire children. Close monitoring during
therapy allows for the early diagnosis of complications, and close follow up of patients after the completion of
therapy is necessary to monitor for relapse and development of long-term complications such as
myelodysplastic syndrome and leukaemia. Despite these complications, given the potential for cure rates in this young group of patients, the benefits far outweigh the risks.