Late toxicity following curative treatment of testicular cancer

Cisplatin appears to be the major cause for long-term toxicity in patients treated for testicular cancer. Long-term side effects consist mainly of nep hrotoxicity, ototoxicity, and neurotoxicity as well as gonadal damage. Foll owing standard-dose chemotherapy approximately 20% to 30% of patients will be affected by long-term side effects, although not all these side effects will cause an impaired quality of life. Several strategies have been or cur rently are being evaluated to reduce acute and long-term complications incl uding the introduction of equally effective, but less toxic regimens, or th e use of cytoprotective agents such as amifostine. Secondary acute myeloid leukemia and secondary myelodysplastic syndrome probably represent the wors t possible long-term complications of cancer therapy in those patients who originally were cured of their primary testicular cancer. Therapy-related s olid tumors are mainly associated with the use of radiation therapy and the risk for developing a therapy-related solid tumor is increased approximate ly two to three times compared to the general population. In contrast, ther apy-related leukemias are predominantly associated with chemotherapy, parti cularly with the use of topoisomerase-II inhibitors and alkylating agents. In general, the cumulative incidence of therapy-related leukemia following treatment of germ cell cancer is low. It is approximately 0.5% and 2% at 5 years of median follow-up for patients receiving etoposide at cumulative do ses less than or equal to 2 g/m(2) and >2 g/m(2), respectively. The risk-be nefit analysis in patients with testicular cancer clearly favors the use of current treatment regimens including high-dose chemotherapy. However, even the acceptably low number of therapy-related long-term complications shoul d encourage the search for equally effective but less toxic therapies. This review will highlight important available data about therapy-related toxic ity and particularly, therapy-related malignancies following cisplatin-etop oside-based chemotherapy. Semin. Surg. Oncol, 17:275-281, 1999. (C) 1999 Wi ley-Liss, Inc.