Haugnes Hege S, Oldenburg Jan, Bremnes Roy M
Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Urol Oncol. 2015 Sep;33(9):399-406. doi: 10.1016/j.urolonc.2014.11.012. Epub 2014 Dec 29.
Testicular cancer (TC) is the most common solid organ malignancy among young men at their peak of family life, education, and career. The exceptionally high cure rates are hampered by an increased risk of several treatment-related toxicities that may emerge several years after treatment. In this article, we review the current knowledge regarding pulmonary and cardiovascular toxicity in long-term survivors of TC. Bleomycin pulmonary toxicity is associated with the cumulative bleomycin dose, renal function, age and smoking status and can be avoided by a careful patient evaluation before chemotherapy. Lung function assessments are not routinely recommended for detecting bleomycin pulmonary toxicity. Long-term decreased pulmonary function may also be related to other chemotherapy agents such as cisplatin. Cardiovascular disease represents one of the most serious late effects of cytotoxic treatment in TC survivors and typically appears several years to decades after treatment. The increased risk for cardiovascular disease is probably mediated by a direct vascular damage from cytotoxic treatment that may stimulate the endothelium, possibly ultimately inducing the atherosclerotic process, as well as an indirect cytotoxic effect by increasing the levels of cardiovascular risk factors. Follow-up of these cancer survivors should include recommendations for maintaining a healthy lifestyle to reduce the risk of future cardiovascular events and to avoid declining pulmonary function.
睾丸癌（TC）是处于家庭生活、教育和事业巅峰期的年轻男性中最常见的实体器官恶性肿瘤。极高的治愈率受到多种治疗相关毒性风险增加的阻碍，这些毒性可能在治疗后数年出现。在本文中，我们综述了目前关于睾丸癌长期幸存者肺部和心血管毒性的知识。博来霉素肺毒性与博来霉素累积剂量、肾功能、年龄和吸烟状况有关，化疗前仔细评估患者可避免这种毒性。通常不建议常规进行肺功能评估来检测博来霉素肺毒性。长期肺功能下降也可能与其他化疗药物如顺铂有关。心血管疾病是睾丸癌幸存者细胞毒性治疗最严重的晚期效应之一，通常在治疗后数年至数十年出现。心血管疾病风险增加可能是由细胞毒性治疗直接导致的血管损伤介导的，这种损伤可能刺激内皮，最终可能引发动脉粥样硬化过程，以及通过增加心血管危险因素水平产生的间接细胞毒性作用。对这些癌症幸存者的随访应包括保持健康生活方式的建议，以降低未来心血管事件的风险并避免肺功能下降。
