Cardiovascular risk factors & morbidity in long-term survivors of TC.....Abstract

[Paul54]

Evidence of the harm of treatment, although the chemo and radiation protocols were probably harsher decades ago. And good reason to maintain a healthy lifestyle and get regular check-ups.

Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: A 20-year follow-up study - Abstract

Wednesday, 03 November 2010
Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.

hege.sagstuen.haugnes@uit.

To evaluate the prevalence of cardiovascular risk factors and long-term incidence of cardiovascular disease (CVD) in survivors of testicular cancer (TC).

Overall, 990 men treated for unilateral TC (1980 to 1994) were included in this national follow-up study (2007 to 2008). They were categorized into four treatment groups: surgery (n = 206), radiotherapy only (RT; n = 386), chemotherapy only (n = 364), and combined RT/chemotherapy (n = 34). Age-matched male controls from the general population (ie, NORMs) were included (n = 990). Survivors of TC who were diagnosed with CVD before or within 2 years after the TC diagnosis were excluded from analyses of CVD end points.

Median observation time was 19 years (range, 13 to 28 years). All cytotoxic treatment groups had significantly increased prevalences of antihypertensive medication, and survivors in the RT and RT/chemotherapy groups had higher prevalences of diabetes (RT: odds ratio [OR], 2.3; 95% CI, 1.5 to 3.7; RT/chemotherapy: OR, 3.9; 95% CI, 1.4 to 10.9) compared with NORMs. Overall 74 survivors of TC (8.0%) experienced atherosclerotic disease during follow-up. Increased risks for atherosclerotic disease were observed in age-adjusted Cox regression analyses after any cytotoxic treatment when compared with surgery only (RT: hazard ratio [HR], 2.3; 95% CI, 1.04 to 5.3; chemotherapy: HR, 2.6; 95% CI, 1.1 to 5.9; RT/chemotherapy: HR, 4.8; 95% CI, 1.6 to 14.4). Treatment with cisplatin, bleomycin, and etoposide (BEP) alone had a 5.7-fold higher risk (95% CI, 1.9 to 17.1 fold) for coronary artery disease compared with surgery only and a 3.1-fold higher risk (95% CI, 1.2 to 7.7 fold) for myocardial infarction compared with NORMs.

Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly the BEP regimen, increases the long-term risk for CVD in survivors of TC.

Written by:
Haugnes HS, Wethal T, Aass N, Dahl O, Klepp O, Langberg CW, Wilsgaard T, Bremnes RM, Fosså SD. Are you the author?

Reference: J Clin Oncol. 2010 Oct 20;28(30):4649-57.
doi: 10.1200/JCO.2010.29.9362

PubMed Abstract
PMID: 20855830

UroToday.com Testicular Cancer Section

[Davepet]

Evidence of the harm of treatment, although the chemo and radiation protocols were probably harsher decades ago. And good reason to maintain a healthy lifestyle and get regular check-ups.

Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: A 20-year follow-up study - Abstract

Wednesday, 03 November 2010
Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.

hege.sagstuen.haugnes@uit.

To evaluate the prevalence of cardiovascular risk factors and long-term incidence of cardiovascular disease (CVD) in survivors of testicular cancer (TC).

Overall, 990 men treated for unilateral TC (1980 to 1994) were included in this national follow-up study (2007 to 2008). They were categorized into four treatment groups: surgery (n = 206), radiotherapy only (RT; n = 386), chemotherapy only (n = 364), and combined RT/chemotherapy (n = 34). Age-matched male controls from the general population (ie, NORMs) were included (n = 990). Survivors of TC who were diagnosed with CVD before or within 2 years after the TC diagnosis were excluded from analyses of CVD end points.

Median observation time was 19 years (range, 13 to 28 years). All cytotoxic treatment groups had significantly increased prevalences of antihypertensive medication, and survivors in the RT and RT/chemotherapy groups had higher prevalences of diabetes (RT: odds ratio [OR], 2.3; 95% CI, 1.5 to 3.7; RT/chemotherapy: OR, 3.9; 95% CI, 1.4 to 10.9) compared with NORMs. Overall 74 survivors of TC (8.0%) experienced atherosclerotic disease during follow-up. Increased risks for atherosclerotic disease were observed in age-adjusted Cox regression analyses after any cytotoxic treatment when compared with surgery only (RT: hazard ratio [HR], 2.3; 95% CI, 1.04 to 5.3; chemotherapy: HR, 2.6; 95% CI, 1.1 to 5.9; RT/chemotherapy: HR, 4.8; 95% CI, 1.6 to 14.4). Treatment with cisplatin, bleomycin, and etoposide (BEP) alone had a 5.7-fold higher risk (95% CI, 1.9 to 17.1 fold) for coronary artery disease compared with surgery only and a 3.1-fold higher risk (95% CI, 1.2 to 7.7 fold) for myocardial infarction compared with NORMs.

Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly the BEP regimen, increases the long-term risk for CVD in survivors of TC.

Written by:
Haugnes HS, Wethal T, Aass N, Dahl O, Klepp O, Langberg CW, Wilsgaard T, Bremnes RM, Fosså SD. Are you the author?

Reference: J Clin Oncol. 2010 Oct 20;28(30):4649-57.
doi: 10.1200/JCO.2010.29.9362

PubMed Abstract
PMID: 20855830

UroToday.com Testicular Cancer Section

Hmmm, as a 35 year survivor, I guess I might have something to say about this. When I had my first TC, chemo & radiation were not very common, if they were available at all. I was one of the few lucky ones that got diagnosed & treated early enough to beat this disease. This test didn't start until I was already a 6 year survivor.

There aren't very many folks my age that were diagnosed 35 years ago that are still alive, if the average age & dates of dx of the TC guys on this forum are any indication.

It is probably important to research these trends, as TC treatments continue to get closer to the 100% cure rate, since that means more of us will now live those 20+ years to experience the long term side effects of the treatments. However, almost none of us would have lived that long without the treatments, so maybe some cardio risks are worth trading off for the chance to live long enough to get them.

Dave