Solid Tumors After Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study

Abstract

A B S T R A C T PurposeIncreased risks of solid tumors after older radiotherapy strategies for testicular cancer (TC) are well established. Few population-based studies, however, focus on solid cancer risk among survivors of TC managed with nonradiotherapy approaches. We quantified the site-specific risk of solid cancers among testicular nonseminoma patients treated in the modern era of cisplatin-based chemotherapy, without radiotherapy. Patients and MethodsStandardized incidence ratios (SIRs) for solid tumors were calculated for 12,691 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2008) and treated initially with either chemotherapy (n ϭ 6,013) or surgery (n ϭ 6,678) without radiotherapy. Patients accrued 116,073 person-years of follow-up. ResultsTwo hundred ten second solid cancers were observed. No increased risk followed surgery alone (SIR, 0.93; 95% CI, 0.76 to 1.14; n ϭ 99 solid cancers), whereas significantly increased 40% excesses (SIR, 1.43; 95% CI, 1.18 to 1.73; n ϭ 111 solid cancers) occurred after chemotherapy. Increased risks of solid cancers after chemotherapy were observed in most follow-up periods (median latency, 12.5 years), including more than 20 years after treatment (SIR, 1.54; 95% CI, 0.96 to 2.33); significantly increased three-to seven-fold risks occurred for cancers of the kidney (SIR, 3.37; 95% CI, 1.79 to 5.77), thyroid (SIR, 4.40; 95% CI, 2.19 to 7.88), and soft tissue (SIR, 7.49; 95% CI, 3.59 to 13.78). ConclusionTo our knowledge, this is the first large population-based series reporting significantly increased risks of solid cancers among patients with testicular nonseminoma treated in the modern era of cisplatin-based chemotherapy. Subsequent analytic studies should focus on the evaluation of dose-response relationships, types of solid cancers, latency patterns, and interactions with other possible factors, including genetic susceptibility.

Residual Platinum Concentrations in Post-Cancer Chemotherapy and Healthy Control Populations Using an Automated, 96-Well Plate Method and Inductively Coupled Plasma Mass Spectrometry

“…Prior studies have established strong dose-response relationships between cumulative cisplatin dose and secondary leukemia, and analytic investigations of solid tumor risk are needed (27,28). Fung et al showed that 3-fold increased risks of kidney cancer follow chemotherapy for testicular cancer (29), and in this regard, it is noteworthy that increased urine concentrations of Pt have also been observed for several decades after platinum administration [reviewed in (1)]. …”

Long-term Relative Survival after Diagnosis of Testicular Germ Cell Tumor

“…As such, firm conclusions regarding the impact of different therapeutic strategies on RS cannot be drawn. Particularly, patients treated with surgery alone might not be at increased risk of cardiovascular disease or second malignant neoplasms (2,6) and are likely to have a higher RS.…”

“…There could be an innate susceptibility for other diseases among TGCT patients, perhaps different from patients with malignant melanoma and even between seminomas and nonseminomas. CT scans traditionally used in the follow-up may have increased the risk of conditions such as second malignant neoplasms (2,6).…”

“…Despite today's excellent 10-year survival rates of above 95%, TGCT treatment is associated with an increased risk of potentially life-threatening late effects. The most important are second malignant neoplasms and cardiovascular disease, usually manifesting beyond 10 years of follow-up (1)(2)(3)(4)(5)(6)(7)(8). Even more alarming are the reports on increased mortality from these and other conditions in TGCT survivors (1-4, 9, 10).…”

Urologia onkologiczna — co zmieniło się w ciągu ostatnich 25 lat?

“…nadciśnienie tętnicze, zaburzenia lipidowe, otyłość, zaburzenia metabolizmu glukozy, ryzyko incydentów sercowo-naczyniowych czy zmniejszenie masy kostnej [34], -zwiększone ryzyko nowotworów indukowanych leczeniem (second malignant neoplasm, SMN) -ryzyko litego SMN jest tym większe, im w młodszym wieku było zastosowane leczenie nzj (chemioterapia i/lub radioterapia). Współcześnie stosowana chemioterapia z użyciem cisplatyny jest związana z 40-procentowym wzrostem ryzyka zachorowania na lity SMN [35]. Po zakończeniu chemioterapii opisywane jest również zwiększone ryzyko wystąpienia białaczek, głównie ostrej białaczki szpikowej.…”