Intermediate and long-term complications associated with adjuvant chemotherapy for stage I germ cell tumor patients

Although platinum-based chemotherapy (CHT) remains the cornerstone of clinical stage I testicular germ cell tumor (GCT) treatment, its long-term toxicity and complications in cancer survivors are unclear.

Cardiovascular disease and secondary malignancies represent the most life-threatening long-term complications and typically occur 10 years after treatment. Other potential intermediate deleterious effects include pulmonary toxicity, ototoxicity, neurotoxicity, hypogonadism and infertility. The incidence and time to onset vary according to patients' genetic susceptibility, CHT regimen and cumulative dosage. Genetic variability may play an important role as a harbinger of future disease and the development of biomarkers may help predict organ damage. Efforts should be concentrated in developing individualized strategies to identify patients who are at high risk of developing long-term complications after CHT for testicular GCTs.

The treatment of clinical stage I testicular GCTs represents the paradigm of a curable malignancy and one of the greatest oncological advances of the twentieth century. Since the introduction of platinum-based CHT in the late 1970s, the 10-year survival rates exceed 95% today and patients can expect to live decades after being successfully treated. The curative nature of GCT treatment, however, is a double-edged sword and is hindered by an increased risk of potential intermediate and long-term complications. The recent focus of clinical research has thus shifted into the prevention of treatment-related long-term effects.