CODE: 21 - Late neurotoxicity of BEP regimen among testicular cancer patients
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Małgorzata Sadowska ¹, Paweł Wiechno ¹, Ewa Nagańska ², Beata Paluchowska ¹, Tomasz Demkow ¹

¹ Klinika Nowotworów Układu Moczowego Centrum Onkologii w Warszawie
² Oddział Kliniczny Neurologii i Epileptologii CMKP w Warszawie

summary

Introduction. Testicular cancer is the most common neoplasm among young men. Standard chemotherapy for metastatic disease is BEP regimen (cisplatin, bleomycin, etopozyd).

The aim of the study. Evaluation of late toxicities regarding nervous system in patients with testicular cancer treated with orchidectomy and standard BEP regimen in comparison to patients treated with orchidectomy alone is presented.

Material and methods. From February 2003 till July 2004, 153 patients (median age 37 year, range: 19-70) were enrolled into the study. The first group consisted of 93 men with metastatic testicular cancer, treated with orchidectomy and standard BEP regimen (3-10 courses, median 4). A control group consisted of 60 patients with stage I testicular cancer treated with orchidectomy alone. Disease free survival was at least 2 years, median - 74 months (range: 24-327). The patients who failed first line treatment were excluded from the study. Authors of the study created an inventory assessing symptoms of the neuropathy and neurotoxicity risk factors, which was completed by every patient. Evaluation of the patient consisted of neurological examination, seeking for the signs of neuropathy and coincidence of neuropathy in physical examination and in medical history, presence of dysautonomia by The Autonomic System Dysfunction Questionnaire modified by Low. Patients' medical history was taken and autonomic nervous system examination was performed for all subjects. 14 men did not attend physical examination. Abnormalities in neurological examination and coincidence of neuropathy in physical examination and in medical history were analyzed for 139 patients.

Results. There were no statistically significant differences in the whole standard neurological examination abnormalities or in the particular part of the examination between two groups. Symptomatic neuropathy was present in 12 (14.8%) patients from chemotherapy group and 6 (10.3%) men without cytotoxic treatment. Statistically significant but low coincidence (p<0.001) of neuropathy in physical examination and in medical history were found. There were no important differences between the two groups regarding total value of the scale (p=0.198) or variable describing scale interpretation (p=0.317) in The Autonomic System Dysfunction Questionnaire modified by Low. Statistically significant differences between examined groups were found in the part of Low Questionnaire regarding vasculomotor symptoms (p=0.005). Dysautonomia rates were similar in BEP and control groups (discrete 63.4% vs. 55%, low 12.9% vs. 13.3%, moderate 4.3% vs. 1.6%). There were no cases of severe dysautonomia found.

Conclusions 1. Standard BEP regimen does not augment neither the frequency of standard neurological examination abnormalities nor symptomatic neuropathy. 2. Chemotherapy with BEP regimen increases the risk of vasculomotor abnormalities.