Originally published as JCO Early Release 10.1200/JCO.2008.18.5181 on May 4 2009

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Pulmonary Function in Long-Term Survivors of Testicular Cancer

From the Institute of Clinical Medicine; and Institute of Community Medicine, University of Tromsø; and Departments of Oncology and of Pneumonology, University Hospital of North Norway, Tromsø; Division of Cancer Medicine and Radiotherapy, Rikshospitalet University Hospital; and Medical Faculty, University of Oslo, Oslo; and Section of Oncology, Institute of Medicine, University of Bergen; and Department of Oncology, Haukeland University Hospital, Bergen, Norway.

Corresponding author: Hege S. Haugnes, MD, Department of Oncology, Institute of Clinical Medicine, University of Tromsø, N-9037 Tromsø, Norway; e-mail: hege.sagstuen.haugnes{at}uit.no.

Purpose Long-term toxicity after cancer treatment has gained increasing clinical attention. We evaluated pulmonary function in long-term survivors of testicular cancer (TC).

Patients and Methods The pulmonary function of 1,049 TC survivors treated during 1980 to 1994 at three university hospitals in Norway was assessed by spirometry and a questionnaire (1998 to 2002). The patients were categorized into five treatment groups, as follows: surgery only (n = 202); radiotherapy only (n = 449); chemotherapy (cisplatin 850 mg; n = 306); chemotherapy (cisplatin > 850 mg [higher-dose group]; n = 62); and chemotherapy and pulmonary surgery (cis/pulmsurg; n = 30). Spirometry variables included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Actual values and percentages of predicted normal values (FVC%pred and FEV1%pred, respectively) are reported. Restrictive lung disease was defined as FEV1/FVC 70% and FVC%pred less than 80%.

Results Median observation time was 11.2 years (range, 5 to 21 years). Compared with the surgery group, the higher-dose or cis/pulmsurg groups had considerably lower age-adjusted FVC (higher-dose: β = –.37; P = .001; cis/pulmsurg: β = –.58; P < .001), FEV1 (higher-dose: β = –.24; P = .014; cis/pulmsurg: β = –.55; P < .001), FVC%pred (higher-dose: β = –8.3; cis/pulmsurg: β = –10.5; bothP < .001), and FEV1%pred (higher-dose: β = –6.8; P = .003; cis/pulmsurg: β = –12.4; P < .001). Adjustment for total testosterone, body mass index, smoking, and physical activity did not change these associations. Eight percent of all patients had restrictive lung disease, and the highest prevalence was in the higher-dose group (17.7%) and the cis/pulmsurg (16.7%) group. Compared with patients who underwent surgery only, these groups had odds ratio for restrictive disease of 3.1 (95% CI, 1.3 to 7.3) and 2.5 (95% CI, 0.8 to 7.6), respectively.

Conclusion Large doses of cisplatin-based chemotherapy and combined chemotherapy/pulmonary surgery are significantly associated with decreased pulmonary function several years after TC treatment.

Supported in part by Grants No. 1998/27 from the Norwegian Foundation for Health and Rehabilitation and No. A4771 from the Aakre Legacy. The study was a National Clinical Study as part of the Norwegian Urologic Cancer Group III project.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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