Journal of Clinical Oncology, Vol 10, 760-765, Copyright © 1992 by American Society of Clinical Oncology
No evidence of acute cardiovascular complications of chemotherapy for testicular cancer: an analysis of the Testicular Cancer Intergroup Study
CR Nichols, BJ Roth, SD Williams, I Gill, FM Muggia, DM Stablein, RB Weiss and LH Einhorn
Department of Medicine, Indiana University School of Medicine, Indianapolis.
PURPOSE: The purpose of this study is to evaluate the risk of acute
vascular events in patients receiving cisplatin-based chemotherapy for
testicular cancer. PATIENTS AND METHODS: A questionnaire assessing
cardiovascular toxicity was distributed to all participants in the
Testicular Cancer Intergroup study and details of toxicity from the
chemotherapy flow sheets were reviewed. Patients with pathologic stage I
testicular cancer were registered on to the study and observed after
retroperitoneal lymphadenectomy. Patients with pathologic stage II disease
were randomized to receive two postoperative courses of adjuvant
cisplatin-based chemotherapy or observation. Any patient who had disease
recurrence after observation or adjuvant therapy was given four cycles of
cisplatin-based chemotherapy. RESULTS: Review treatment- related toxicity
for those patients receiving adjuvant chemotherapy (n = 97) or chemotherapy
for recurrent disease (n = 83) showed no cases of acute cardiovascular
toxicity. The median follow-up period after study enrollment was 5.1 years;
459 questionnaires were mailed and 270 were returned. The percent return
was equal among the observed adjuvant and recurrent groups (59%, 54%, and
64%). There was a significant increase in the incidence of extremity
paresthesias in the two groups receiving chemotherapy. Fatal myocardial
infarction was reported in two patients in the observation group and one
nonfatal infarction was reported in the adjuvant treatment group. No
patient in any group reported an incidence of stroke. Three patients in the
observation group and one patient in the recurrent group experienced a
thromboembolic event. CONCLUSION: Despite sporadic case reports suggesting
a causal association between chemotherapy for testicular cancer and acute
vascular events, this retrospective analysis provides no evidence of an
increased risk for subsequent cardiovascular disease in this patient
population.
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