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  • Review Article
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Late adverse effects and quality of life in survivors of testicular germ cell tumour

Nature Reviews Urology volume 18, pages 227–245 (2021)Cite this article

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Abstract

Currently, ~95% of patients with testicular germ cell tumour (TGCT) are cured, resulting in an increasing number of TGCT survivors. Although cured, these men face potential late adverse effects and reduced quality of life. Survivors face a twofold increased risk of second malignant neoplasms after chemotherapy and radiotherapy, with evidence of dose-dependent associations. For survivors managed with surveillance or treated with radiotherapy, the risk of cardiovascular disease (CVD) is comparable to the risk in the general population, whereas treatment with chemotherapy increases the risk of life-threatening CVD, especially during treatment and after 10 years of follow-up. Other adverse effects are organ-related toxicities such as neuropathy and ototoxicity. Pulmonary and renal impairment in patients with TGCT treated with chemotherapy is limited. Survivors of TGCT might experience psychosocial distress including anxiety disorders, fear of cancer recurrence and TGCT-specific issues, such as sexual dysfunction. Late adverse effects can be avoided in most patients with stage I disease if followed on a surveillance programme. However, patients with disseminated disease can experience toxicities associated with radiotherapy and chemotherapy, and/or adverse effects related to surgery for residual disease. The severity of adverse effects increases with dose of both chemotherapy and radiotherapy. This Review discusses the most recent data concerning the late adverse effects of today’s standard treatments for TGCT.

Key points

  • Survivors of testicular germ cell tumour (TGCT) have a twofold increased risk of a second malignant neoplasm after chemotherapy and radiotherapy, with evidence of dose-dependent associations.

  • The risk of cardiovascular disease (CVD) in patients with TGCT after orchiectomy or radiotherapy is comparable to that in the general population. Treatment with bleomycin–etoposide–cisplatin (BEP) seems to increase the risk of life-threatening CVD especially during treatment and after 10 years of follow-up.

  • Cisplatin-induced peripheral neuropathy is present in 20–30% of patients with TGCT 5 to 10 years after treatment. Neuropathy and ototoxicity are both associated with decreased quality of life.

  • At 5 years after treatment with BEP, pulmonary and renal impairment in survivors of TGCT is limited as the overall function returns to pretreatment status or better in the majority of patients.

  • Leydig cell dysfunction is observed in >20% of TGCT survivors and testosterone substitution is needed in 5–10% of these individuals.

  • Survivors of TGCT experience a variety of long-term conditions causing psychological distress, such as anxiety, fear of recurrence, cancer-related fatigue and cognitive and sexual dysfunction.

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Fig. 1: Overview of late adverse effects in survivors of testicular germ cell tumour.
Fig. 2: Pulmonary function in patients with testicular germ cell tumour who have received treatment with BEP.
Fig. 3: Relative change in renal function before, during and after treatment with BEP measured by 51Cr-EDTA clearance.
Fig. 4: Psychosocial factors affecting survivors of testicular germ cell tumour.

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Acknowledgements

The work of M.C. is supported by the Slovak Research and Development Agency under contract no. APVV-15-0086 and APVV-19-0411.

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Authors and Affiliations

  1. 2nd Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovakia

    Michal Chovanec

  2. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Jakob Lauritsen, Mikkel Bandak, Gry Gundgaard Kier, Michael Kreiberg, Josephine Rosenvilde, Thomas Wagner & Gedske Daugaard

  3. Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christoph Oing & Carsten Bokemeyer

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Chovanec, M., Lauritsen, J., Bandak, M. et al. Late adverse effects and quality of life in survivors of testicular germ cell tumour. Nat Rev Urol 18, 227–245 (2021). https://doi.org/10.1038/s41585-021-00440-w

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