DOSE-DEPENDENT IMPAIRMENT OF TESTICULAR FUNCTION IN PATIENTS TREATED WITH CISPLATIN-BASED CHEMOTHERAPY FOR GERM-CELL CANCER

Background: The enormous differences in semen quality following cisplatin-based combination chemotherapy reported in previous studies may be caused by differences in the cisplatin dosages. Patients and methods: We examined thirty-three patients treated with conventional-dose PEB (cisplatin 20 mg/m2 x 5, q3w. etoposide 100 mg/m2 x 5 q3w and bleomycin 15 mg/m2 q1w) and 21 patients treated with high-dose PEB (cisplatin 40 mg/m2 x 5 q3w, etoposide 200 mg/m2 x 5 q3w and bleomycin 15 mg/m2 q1w). Results: The sperm density was significantly higher (median 5.83 mill/ml) in the conventionally-treated group than in the group of high-dose-treated patients (median 0.005 mill/ml) (p = 0.008). Azoospermia was present in 19% of the conventionally- and in 47% of the high-dose-treated patients. All patients treated with a cumulative cisplatin dose above 600 mg/m2 had severe oligospermia or azoospermia. Serum values of basal follicle-stimulating hormone (FSH) (median 27.2 iu/l vs. 15.2 iu/l) and stimulated FSH (median 57.7 iu/l vs. 28.4 iu/l) were significantly higher in the high-dose group than in the conventionally-treated group. No differences could be detected in basal or stimulated testosterone or in luteinizing hormone in serum. Conclusion: In patients treated with PEB for testicular cancer, we found strong evidence that the impairment of spermatogenesis is dose-dependent.