Patients who received platinum-based chemotherapy or radiotherapy to treat testicular cancer had a considerably higher risk of dying from causes unrelated to their primary cancer, in line with a study printed in the Journal of Clinical Oncology.
In a population-based study, researchers examined whether or not platinum-based chemotherapy and radiotherapy were the key risk elements for extra mortality among testicular cancer survivors.
The study included 5707 patients from the Cancer Registry of Norway who has been diagnosed with testicular cancer from 1980 to 2009. The patients were treated with surgery alone (25%), platinum-based chemotherapy (44%), radiotherapy (27%), or chemotherapy plus radiotherapy (4%).
The patients were followed for a median of 18.7 years. Throughout that point, 665 patients (12%) died from causes unrelated to testicular cancer.
The overall non-testicular cancer mortality was considerably increased in the study cohort in contrast with the general population. The standardized mortality ratio (SMR) was 1.23, and absolutely the excess risk (AER) was 11.14.
The highest non-testicular cancer mortality was noticed in patients who have been younger than 20 years of age at testicular cancer diagnosis (SMR, 2.27; AER, 14.42).
There was a considerably increased danger of non-testicular cancer death among patients who obtained chemotherapy (SMR, 1.23; AER, 7.68), radiotherapy (SMR, 1.28; AER, 19.55), and chemotherapy plus radiotherapy (SMR, 2.04; AER, 75.45) but not among patients who underwent surgery alone (SMR, 0.95; AER, -2.21).
Second cancer was a “crucial explanation for death” unrelated to testicular cancer, according to the researchers. The overall SMR for a second cancer was 1.53, and the AER was 7.94.
The risk of death from a second cancer was among patients who obtained chemotherapy (SMR, 1.43; AER, 4.25), radiotherapy (SMR, 1.59; AER, 13.38), and chemotherapy plus radiotherapy (SMR, 3.24; AER, 50.13) but not among these underwent surgery alone (SMR, 1.13; AER, 1.71).
Patients, who obtained chemotherapy, had a considerably increased risk of lung cancer (SMR, 1.69), leukemia (SMR, 3.26), esophageal cancer (SMR, 3.74), bladder cancer (SMR, 6.33) as well as cancers of the oral cavity and pharynx (SMR, 6.82).
Patients who received radiotherapy had a significantly increased risk of liver cancer (SMR, 3.02), stomach cancer (SMR, 3.15), cancers of the oral cavity and pharynx (SMR, 4.28), pancreatic cancer (SMR, 4.36), and bladder cancer (SMR, 4.91).
Patients who received chemotherapy plus radiotherapy had a considerably increased risk of abdomen cancer (SMR, 12.85), pancreatic cancer (SMR, 6.86), and prostate cancer (SMR, 3.27).
In comparison with surgery in a multivariable evaluation, the overall risk of non-testicular cancer mortality was significantly increased with chemotherapy (hazard ratio [HR], 1.42), radiotherapy (HR, 1.94), and chemotherapy plus radiotherapy (HR, 3.27).
In comparison with the final inhabitants, the patient cohort had an increased risk of non-cancer mortality (SMR, 1.15; AER, 4.71).
An evaluation of the non-cancer causes of death revealed an extra of suicides in patients who received chemotherapy (SMR, 1.65) and an increased risk of death from ailments of the genitourinary system in patients who received chemotherapy (SMR, 3.29).
Radiotherapy was related to an increased risk of death from ailments of the digestive system (SMR, 2.46) while chemotherapy plus radiotherapy was related to an increased risk of death from sure coronary heart ailments (SMR, 5.30).
The researchers concluded that platinum-based chemotherapy and radiotherapy are related to an increased risk of non-testicular cancer mortality while each health professionals and patients “ought to concentrate on the risk of premature death.”
Hellesnes R, Myklebust TA, Fossa SD, et al. Testicular cancer in the cisplatin era: Causes of death and mortality rates in a population-based cohort. J Clin Oncol. Published online August 13, 2021. doi:10.1200/JCO.21.00637