Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors

Haugnes, Hege Sagstuen; Aass, Nina; Fosså, Sophie D.; Dahl, Olav; Klepp, Olbjørn; Wist, Erik; Wilsgaard, Tom; Bremnes, Roy M.

doi:10.1007/s11764-008-0054-1

Cited by 39 publications

(30 citation statements)

References 48 publications

(102 reference statements)

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“…Apartfromtumorrecurrence,follow-upschedulesshould include the detection of long-term side effects of chemotherapyandradiotherapy.Hypogonadism,metabolicsyndrome, andcardiovasculardiseaseaswellassecondarymalignancies arethemostimportantlong-termsequelae [15][16][17][18][19].Especially patientswhounderwentbothchemotherapyandradiotherapy haveanexcessiveriskforcardiovasculareventsorsecondary tumors [17].…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Cathomas

Hartmann²,

Krege³

et al. 2011

Oncol Res Treat

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Over the last years, clear treatment recommendations for patients with testicular cancer have been published. This has led to significant improvements in outcome and survival. Moreover, active surveillance has become a cornerstone in the management of clinical stage I seminomatous and non-seminomatous germ cell tumors. On the other hand, the existing recommendations for the follow-up of testis cancer patients are unclear and differ widely. Follow-up recommendations in this young patient population have to be as evidence based as possible, feasible in order to ensure adherence, and must not be harmful. Therefore, attention has to be paid to the negative impact of unnecessary radiation exposure. Recently, new evidence became available regarding the relapse pattern of different disease stages of testicular cancer, the use of imaging at follow-up, and the risks of excessive radiation due to imaging, and in particular that of computed tomography (CT) scans. This article summarizes the recommendations for follow-up of testicular cancer patients of an interdisciplinary multinational working group consisting of urologists, medical oncologists, and radiation oncologists.

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Section: Introductionmentioning

confidence: 99%

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Cathomas

Hartmann²,

Krege³

et al. 2011

Oncol Res Treat

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“…A long-term follow-up in a large cohort of testicular cancer survivors showed that compared with healthy controls, cisplatin-treated patients had, at follow-up, increased systolic blood pressure, increased diastolic blood pressure and a higher prevalence of hypertension (18). In that cohort, patients in the high-dose cisplatin-treated group had increased odds for having intermediate/high risk in cardiovascular mortality, compared with the surgery group (OR=3.4, 95% CI: 1.3-8.7) (17). All of the above case reports led to the hypothesis that cisplatin may cause deleterious effects on the cardiovascular system.…”

Section: Discussionmentioning

confidence: 96%

“…In particular, the vasomotor reactions have been reported to be related to plasma volume and to help maintaining cardiovascular homeostasis (13). Although in previous studies it was reported that cisplatin is associated with a higher incidence of cardiovascular mortality and morbility (17,18), the effect of cisplatin on vascular tone remains to be elucidated. Therefore, the aim of the present study was to evaluate the cardiovascular toxicity of cisplatin on the contractile function of rat thoracic aortas and to elucidate the possible underlying mechanisms.…”

Section: Introductionmentioning

confidence: 96%

Effects of cisplatin on the contractile function of thoracic aorta of Sprague-Dawley rats

et al. 2014

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Abstract. DNA-damaging agents have been reported to be associated with cardiovascular complications, however, the underlying mechanisms remain to be clarified. In the present study, the possible vascular effects of cisplatin was assessed by measuring its effects on the contractile function of thoracic aortic rings dissected from Sprague-Dawley (SD) rats. Contraction of the aortic ring was induced by 60 mM KCl or 10 -6 M phenylephrine (PE) in an ex vivo perfusion system. Cisplatin (200 µM) counteracted KCl-and PE-induced contraction by 57.6 and 91.8%, respectively, in endothelium-intact aortic rings. Similar results were obtained in endothelium-denuded aortas. Electromicroscopy analysis revealed severe damage to blood vessel walls in vivo by cisplatin. In addition, cisplatin significantly inhibited adenosine triphosphate (ATP)-induced intracellular Ca 2+ concentration ([Ca 2+ ] i ) increases in human umbilical vein endothelial cells (HUVECs). These results suggested that the DNA-damaging agent cisplatin can affect the contractile function of thoracic aortas. In addition, in accordance with its DNA-damaging properties, the cardiovascular toxicity of cisplatin may be the result of its direct cytotoxicity. IntroductionDNA-damaging agents, or genotoxic agents, are those chemicals that can produce alterations in the genetic material of the host. Such agents can be further subdivided into direct-and indirect-acting agents. Direct-acting agents are intrinsically reactive and do not require metabolic activation by cellular enzymes to interact with DNA. By contrast, indirect-acting agents require metabolic activation by cellular enzymes to form the DNA-reactive metabolite. DNA-damaging agents exist widely in our natural and social environment, with examples including some of the chemotherapeutic agents and environmental pollutants (1).Cisplatin, a direct-acting agent, is one of the most widely used chemotherapeutic agents in the treatment of a wide variety of malignancies (2). Although its biochemical mechanism of action has yet to be elucidated, cisplastin is believed to exert cytotoxic effects through the interaction and formation of adducts with DNA, which then leads to apoptosis and necrosis (3,4). Despite its clinical efficacy in treating malignancies, cisplatin-based chemotherapy regimens have been reported to be associated with vascular toxicity and serious vascular complications (e.g., myocardial infarction and stroke) (5-7). Such vascular toxicity has been manifested by increased von Willebrand factor plasma levels as well as an enhanced intima-media thickness of the carotid artery (8). In addition, cisplatin has the potential to induce ototoxicity and toxicity towards renal, peripheral sensory and autonomic nervous systems, potentially attributed to cisplatin-caused microvascular damage (9-11). Ca 2+ plays an important role in the regulation of vascular tone, which is generally relatively constant. Initiation of contraction in vascular smooth muscle is due to an increase in the free cytosolic Ca 2+ concentr...

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“…The risk of the above long-term complications seems to be positively associated with the level of intensity of cancer treatment. [17][18][19] Whether the latter is caused by hypogonadism, which is more frequent in these patients as compared to the background population, is not yet known. However, low testosterone levels were reported as a marker of not only increased morbidity but also of mortality.…”

Section: Hypogonadism and Osteoporosismentioning

confidence: 98%

“…14,15 Nevertheless, in parallel with the increased incidence, a significant improvement in survival rates has been achieved and today, in the best centers, more than 95% of TGCC patients are cured. [17][18][19] Whether these diseases are fully or partially due to testosterone deficiency is so far unknown. However, there is no doubt that TGCC as such, as well as the therapy given, may constitute a hazard to reproductive function.…”

Section: Testicular Cancermentioning

confidence: 99%

Hypogonadism in young men treated for cancer

Giwercman¹,

Giwercman²

2015

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An ever-increasing proportion of young males treated for cancer are cured. Therefore, one of the major challenges of modern Clinical Oncology is to ensure good quality of life. Cancer disease per se as well as cancer treatment may have a negative impact on androgen production, thereby leading to subclinical or clinically overt hypogonadism. Since the symptoms of androgen deficiency are rather unspecific, it is important that reproductive hormone levels be checked in young men who have been treated for cancer. As androgen deficiency in men is associated with increased long-term risk of osteoporosis as well as cardiovascular and metabolic disease, those cancer survivors who present with signs of insufficient androgen production should be followed and preventive as well as therapeutic measures, including androgen replacement therapy, should be applied according to the current guidelines.

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Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors

Abstract: TC survivors should be followed regularly with respect to cardiovascular risk profile beyond the routine 10-year clinical follow-up.

Cited by 39 publications

References 48 publications

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Effects of cisplatin on the contractile function of thoracic aorta of Sprague-Dawley rats

Hypogonadism in young men treated for cancer

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