[Late damage of curative oncologic therapy. Results of a patient sample with Hodgkin's disease and testicular tumors at the Hannover Medical School].

BACKGROUND: The present analysis deals with 2 main problems among therapy-associated late toxicities in patients after curative treatment for malignant tumors, such as Hodgkin's disease and testicular cancer: gonadal late toxicities in young patients after treatment for lymphomas and the risk of secondary neoplasia after curative treatment for malignant male germ cell tumors. PATIENTS/RESULTS: In 66 patients with Hodgkin's disease and 24 patients with non-Hodgkin's lymphomas ( < 45 years), who were in complete remission for more than 2 years after chemo- and/or radiotherapy, gonadal damages were analysed based on hormone levels (FSH, LH, testosterone, estrogen), clinical examination and patients' histories. 50% of female patients with Hodgkin's disease suffered from premature ovarian failure and 65% of men were either sub- or infertile. In contrast, only 18% of patients treated for non-Hodgkin's lymphoma showed signs of gonadal toxicity. The risk for gonadal toxicity in patients with Hodgkin's disease was related to the use of procarbacine as a part of the COPP-regimen and to infradiaphragmatic radiotherapy. Sperm conservation should be offered to male patients prior to therapy. In female patients with Hodgkin's disease hormone levels should be evaluated after therapy and substitution should be initiated early in order to avoid osteoporosis, an increased cardiovascular risk and psychological problems. In patients with testicular cancer it could be demonstrated that current therapeutic strategies are associated with a small but identifiable risk for secondary neoplasia: radiotherapy causes a 2- to 3-fold increased risk for solid cancers and chemotherapy, particularly the use of etoposide-based regimens, is associated with secondary leukemias. However, a risk-benefit analysis shows that cure rates above 80% for patients with metastatic disease will outweigh the risk of secondary neoplasia. CONCLUSION: The investigation of therapy-associated late toxicities will remain an important issue even with the use of new treatment approaches such as high-dose therapy. Prospective evaluation of late toxicities needs to be incorporated into new studies for the curative treatment of malignant tumors.