Stuart N S, Woodroffe C M, Grundy R, Cullen M H
Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Br J Cancer. 1990 Mar;61(3):479-84. doi: 10.1038/bjc.1990.106.
Twenty-seven patients cured of advanced testicular cancer by cisplatin-based chemotherapy have been assessed, a median of 30 months after start of treatment, for the long-term effects of such treatment on renal, endocrine, audiometric, reproductive and respiratory function. To control for the effects of orchidectomy on endocrine function a similar group of 11 patients cured by orchidectomy alone was also assessed. The extents of impairment in hearing and renal function were related to the total dose of cisplatin received, while the majority of patients had respiratory impairment which was, in part, related to the total dose of bleomycin. TSH was significantly higher in the chemotherapy group although serum free thyroxine and free T3 were normal in all. FSH was raised in 67% of the chemotherapy group although serum free thyroxine and free T3 were while LH was raised in 75% and 45% respectively. Serum testosterone was normal in all. The levels of FSH and LH were both independently correlated with age of the patient while FSH was higher in patients having more chemotherapy and had a tendency to fall towards normal with time since treatment. Over half the patients had normal sperm concentrations although 74% had a raised proportion of abnormal sperm. Indices of sperm function were worse in patients having more chemotherapy but sperm number increased towards normal with time since treatment, particularly after the second year. The long-term side-effects of chemotherapy for testicular cancer are thus generally mild but are largely irreversible and their severity is related to the total amount of chemotherapy received. As their longer term significance is not clear we would recommend that, in the treatment of testicular cancer, doses of chemotherapy are reduced to the minimum required for cure. Assessment of long-term side-effects of chemotherapy for testicular cancer should be a mandatory part of any study of such treatment and should be considered in any comparison of different therapies.
对27例通过以顺铂为基础的化疗治愈的晚期睾丸癌患者进行了评估，评估时间为治疗开始后的中位30个月，以了解这种治疗对肾脏、内分泌、听力、生殖和呼吸功能的长期影响。为了控制睾丸切除术对内分泌功能的影响，还对一组类似的11例仅通过睾丸切除术治愈的患者进行了评估。听力和肾功能损害程度与接受的顺铂总剂量有关，而大多数患者存在呼吸功能损害，部分与博来霉素总剂量有关。化疗组促甲状腺激素显著升高，尽管所有患者血清游离甲状腺素和游离T3均正常。化疗组67%的患者促卵泡生成素升高，而血清游离甲状腺素和游离T3正常，促黄体生成素分别在75%和45%的患者中升高。所有患者血清睾酮均正常。促卵泡生成素和促黄体生成素水平均与患者年龄独立相关，接受更多化疗的患者促卵泡生成素水平更高，且自治疗后有随时间趋于正常的趋势。超过一半的患者精子浓度正常，尽管74%的患者异常精子比例升高。接受更多化疗的患者精子功能指标更差，但自治疗后精子数量随时间趋于正常，尤其是在第二年之后。因此，睾丸癌化疗的长期副作用一般较轻，但大多不可逆，其严重程度与接受的化疗总量有关。由于其长期意义尚不清楚，我们建议在睾丸癌治疗中，将化疗剂量降至治愈所需的最低水平。对睾丸癌化疗长期副作用进行评估应是此类治疗任何研究的必要组成部分，并且在比较不同疗法时应予以考虑。
