Nichols C R, Roth B J, Williams S D, Gill I, Muggia F M, Stablein D M, Weiss R B, Einhorn L H
Department of Medicine, Indiana University School of Medicine, Indianapolis.
J Clin Oncol. 1992 May;10(5):760-5. doi: 10.1200/JCO.1992.10.5.760.
The purpose of this study is to evaluate the risk of acute vascular events in patients receiving cisplatin-based chemotherapy for testicular cancer.
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.
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.
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.
本研究旨在评估接受顺铂为基础的化疗方案治疗睾丸癌的患者发生急性血管事件的风险。
向睾丸癌国际协作组研究的所有参与者发放一份评估心血管毒性的问卷，并查阅化疗流程表中的毒性细节。病理分期为I期的睾丸癌患者登记参加本研究，并在腹膜后淋巴结清扫术后进行观察。病理分期为II期的患者被随机分为两组，一组接受两个疗程的术后辅助顺铂化疗，另一组接受观察。任何在观察或辅助治疗后疾病复发的患者均接受四个疗程的顺铂化疗。
对接受辅助化疗的患者（n = 97）或复发性疾病化疗的患者（n = 83）的治疗相关毒性进行回顾，未发现急性心血管毒性病例。研究入组后的中位随访期为5.1年；共邮寄了459份问卷，270份被退回。观察、辅助治疗和复发组的问卷回收率相当（分别为59%、54%和64%）。接受化疗的两组患者肢体感觉异常的发生率显著增加。观察组有两名患者报告发生致命性心肌梗死，辅助治疗组有一名患者报告发生非致命性心肌梗死。任何组均无患者报告发生中风。观察组有三名患者、复发组有一名患者发生血栓栓塞事件。
尽管有零星病例报告提示睾丸癌化疗与急性血管事件之间存在因果关联，但本回顾性分析未提供证据表明该患者群体后续心血管疾病风险增加。
