NEW YORK (Reuters Health) May 22 - The results of a study published in the May 6 online issue of the Journal of Clinical Oncology suggest that decreased pulmonary function is a long-term adverse effect of cisplatin-based chemotherapy in survivors of testicular cancer.
"Today, germ cell testicular cancer has a favorable prognosis because of the introduction of cisplatin-based chemotherapy in the late 1970s, a multimodal treatment approach, disease monitoring by tumor markers, and more reliable radiologic staging," Dr. Hege S. Haugnes, of the University of Tromso, Norway, and colleagues write.
"Recently, a large international study reported a significantly increased mortality as a result of respiratory diseases among chemotherapy-treated testicular cancer survivors compared with the general population."
To investigate, Dr. Haugnes and associates examined pulmonary function of 1049 long-term testicular cancer survivors treated from 1980 to 1994. The subjects were assessed by spirometry and a questionnaire completed between 1998 and 2002. The median observation time was 11.2 years.
The participants were categorized by treatment group: surgery only (n = 202); radiotherapy only (n = 449); chemotherapy with a cumulative dose of cisplatin less than or equal to 850 mg (n = 306); chemotherapy with a cumulative dose of cisplatin greater than 850 mg (n = 62); or chemotherapy plus pulmonary surgery (n = 30).
Compared with the surgery only group, the higher dose cisplatin group and the cisplatin plus surgery group had significantly lower age-adjusted forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), percentage of predicted FVC value, and percentage of predicted FEV value.
These associations were not changed after adjustment for total testosterone, body mass index, smoking, and physical activity.
A total of 84 patients (8%) developed restrictive lung disease. The highest prevalence was seen in the higher dose cisplatin group and the cisplatin plus surgery group (17.7% and 16.7%, respectively).
"It is well known that bleomycin, also included in the standard chemotherapy regimen for testicular cancer, may cause pulmonary toxicity," Dr. Haugnes said in an interview with Reuters Health. "However, our findings indicate that the decreased pulmonary function observed in our long-term survivors probably is related to cumulative cisplatin doses rather than bleomycin doses."
"All doctors included in the treatment and follow-up of (testicular cancer patients) should be informed about potential long-term treatment-related toxicity," Dr. Haugnes said. "However, these findings need to be confirmed in a large prospective trial with measurements of the pulmonary function both before and after treatment, and should include both spirometry maneuvers and measurements of the lung transfer capacity for carbon oxide."
J Clin Oncol 2009;27.
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