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Journal of Clinical Oncology, Vol 21, Issue 8 (April), 2003: 1513-1523
© 2003 American Society for Clinical Oncology

Cardiovascular Disease as a Long-Term Complication of Treatment for Testicular Cancer

R.A. Huddart, A. Norman, M. Shahidi, A. Horwich, D. Coward, J. Nicholls, D.P. Dearnaley

From the Academic Unit of Radiotherapy and Oncology and Department of Computing and Information, Institute of Cancer Research and Royal Marsden National Health Service Trust, Sutton, Surrey, United Kingdom.

Address reprint requests to R.A. Huddart, MA, PhD, Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Trust and Institute of Cancer Research, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom; email: roberth{at}icr.ac.uk.

Purpose: To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received.

Patients and Methods: All resident male patients registered in the United Kingdom between 1982 and 1992 attending for follow-up were eligible for recruitment. Patients completed a current health questionnaire and underwent clinical review, along with hematologic, biochemical, and hormonal profiles. For patients not under routine review, follow-up information was sought from their general practitioner and mortality data were sought from the Office of National Statistics. Descriptive analysis was performed on all variables and comparisons were made among patients treated by orchidectomy and follow-up only, chemotherapy alone (C), radiotherapy alone (RT), and radiotherapy and chemotherapy (C/RT).

Results: Data on cardiovascular events were available on 992 patients. After a median follow-up of 10.2 years, 68 events had been reported, including 18 deaths. After adjusting for age, increased risk for cardiac events was seen after C (relative risk [RR] = 2.59; 95% confidence interval [CI], 1.15 to 5.84; P = .022), RT (RR = 2.40; 95% CI, 1.04 to 5.45; P = .036), and C/RT (RR = 2.78; 95% CI, 1.09 to 7.07; P = .032). There were no significant differences in cardiac risk factors. On multivariate analysis, age, treatment group, free thyroxine, protein, and magnesium levels were associated with cardiovascular disease.

Conclusion: In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer.

Supported by the Institute of Cancer Research, the Bob Champion Cancer Trust, and Cancer Research UK.

This work was undertaken in the Royal Marsden National Health Service (NHS) Trust, which received a proportion of its funding from the NHS Executive. The views expressed in this article are those of the authors and not necessarily those of the NHS Executive.


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