Berger C C, Bokemeyer C, Schneider M, Kuczyk M A, Schmoll H J
Division of Haematology/Oncology, Hannover University Medical School, Germany.
Eur J Cancer. 1995 Dec;31A(13-14):2229-38. doi: 10.1016/0959-8049(95)00460-2.
182 patients treated with cisplatin-based chemotherapy for testicular cancer at Hannover University Medical School who were in complete remission (CR) for more than 1 year after therapy were randomly selected for the evaluation of late vascular toxicity. 90 patients with a mean age of 28 years (19-53) and a median follow-up of 57.9 months (15-159) participated in this examination. Patients were examined clinically and digital photoelectric pulse plethysmography (PP) and Doppler-flow of the digital arteries after cold exposure were performed. Thirty seven per cent of patients developed symptoms of Raynaud's phenomenon (RP) after chemotherapy, which were transient in 7%. PP proved to be highly diagnostic for RP with a sensitivity of 95% and a specificity of 100%. As significant risk factors for the development of RP, the cumulative dose of bleomycin (P < 0.05) and the use of bleomycin in combination with vinblastine (PVB-regimen) instead of etoposide (PEB-regimen) (P < 0.01) were found. A trend for an increased frequency of RP was observed in patients who received bleomycin as a bolus instead of continuous infusion. No significant correlation was seen with the cumulative or single doses of cisplatin, etoposide or vinblastine, serum magnesium levels during or after chemotherapy or a history of smoking. RP was not associated with the occurrence of neuro- or ototoxicity. All 7 patients with hypertensive blood pressure before chemotherapy developed RP. Furthermore, the median postchemotherapy diastolic blood pressure had increased by 8 mmHg compared to prechemotherapy values, leading to significant hypertension in 8 patients (> 20 mmHg increase). 2 patients developed major vascular events with myocardial infarctions at 4 years and 5 years after chemotherapy, respectively. No cerebral infarction was registered. In summary, RP is the main late vascular toxicity affecting one third of patients after curative chemotherapy for testicular cancer. However, the incidence of RP following PEB-therapy in contrast to PVB-therapy appears to be lower. Major vascular events seem to be rare. The prospective evaluation of late toxicity should be part of current chemotherapy treatment for testicular cancer, and long-term follow-up of surviving patients is recommended.
在汉诺威大学医学院，对182例接受以顺铂为基础的化疗治疗睾丸癌且治疗后完全缓解（CR）超过1年的患者进行随机选择，以评估晚期血管毒性。90例患者参与了此次检查，其平均年龄为28岁（19 - 53岁），中位随访时间为57.9个月（15 - 159个月）。对患者进行临床检查，并进行数字光电脉搏容积描记法（PP）以及冷暴露后指动脉的多普勒血流检查。37%的患者在化疗后出现雷诺现象（RP）症状，其中7%为短暂性症状。PP对RP具有高度诊断价值，敏感性为95%，特异性为100%。发现博来霉素的累积剂量（P < 0.05）以及博来霉素与长春花碱联合使用（PVB方案）而非与依托泊苷联合使用（PEB方案）（P < 0.01）是发生RP的显著危险因素。在接受博来霉素推注而非持续输注的患者中，观察到RP频率增加的趋势。未发现与顺铂、依托泊苷或长春花碱的累积剂量或单次剂量、化疗期间或化疗后的血清镁水平或吸烟史有显著相关性。RP与神经毒性或耳毒性的发生无关。所有7例化疗前患有高血压的患者均出现了RP。此外，化疗后中位舒张压较化疗前值升高了8 mmHg，导致8例患者出现显著高血压（升高> 20 mmHg）。2例患者分别在化疗后4年和5年发生了心肌梗死等重大血管事件。未记录到脑梗死病例。总之，RP是睾丸癌根治性化疗后影响三分之一患者的主要晚期血管毒性。然而，与PVB方案相比，PEB方案治疗后RP的发生率似乎较低。重大血管事件似乎很少见。晚期毒性的前瞻性评估应成为当前睾丸癌化疗治疗的一部分，建议对存活患者进行长期随访。
