Introduction

Cisplatin-based chemotherapy (CBC) is a cornerstone in the treatment of advanced stage testicular cancer (TC). Since its introduction it has led to excellent survival rates and as TC usually is a cancer of young men, most patients live to experience significant short- and long-term side effects. These include infertility, cardiovascular disease, and sensomotoric impairment due to oto- and neurotoxicity. Meanwhile little is known on retinal toxicity associated with CBC. We therefore sought to outline potential morphological and functional retinal alterations in CBC treated patients._x000D_

Methods

After ethics committee approval was obtained, we enrolled patients who had received at least one cycle of CBC at any of three Hamburg-based TC centers. Furthermore, a matched control group of healthy, untreated patients were included in this study. Subjects were evaluated for functional and morphological retinal dysfunction. This included testing of retinal nerve fiber thickness (RNFL), color vision, and visual acuity testing in CBC recipients. Additionally, full-field electroretinograms (ff-ERG) for CBC recipients and their healthy controls were conducted. Pearson correlation coefficient analysis was carried out to assess a possible correlation between cumulative Cisplatin dose and measured RNFL and ff-ERG. Endpoints of this study were differences in test measures as well as a dose dependency on outcomes.

Results

Both study groups (CBC recipients vs. healthy controls) consisted of N=14 participants with a median patient age of 30 years (range: 22 - 52 years). Seminomatous and nonseminomatous germ cell tumors were exhibited in 6 (42.85%), and 8 (57.14%) out of 14 patients, respectively. Patients had received between one to seven cycles of a CBC regimen consisting of Cisplatin, Etoposide, and Bleomycin with a median Cisplatin dose of 627mg (range: 216mg - 1,205mg). The median interval between last CBC and diagnostic evaluation was 19.8 month (range: 6 - 61.5 months)._x000D_ Morphological assessment revealed reduced RNFL in 11 of 14 patients (78.6%). While the reduction in RNFL was significantly correlated to the cumulative CBC dose received (?=0.70; P=0.004), it did not correlate with the time since cessation of CBC (?=0.16; P=0.1). ff-ERG showed significant differences between CBC recipients and the control-group in 2 of 5 tested categories (all P<0.001)._x000D_ Functional testing revealed no loss in visual acuity in all 14 CBC recipients, yet impaired color vision was observed in 6 of 14 patients (42.8%)._x000D_

Conclusions

Our study is limited in small sample size and short-term follow-up. However, it appears that CBC in TC patients leads to short-term functional and morphological retinal alterations. Future studies should address this circumstance, as there are major implications._x000D_

Funding

none