Sobrevivendo ao câncer - seminoma testicular e seu tratamento devem ser tratados como fatores de risco cardiovascular? : estudo de caso e revisão narrativa da literatura
Sobrevivendo ao câncer - seminoma testicular e seu tratamento devem ser tratados como fatores de risco cardiovascular? : estudo de caso e revisão narrativa da literatura
Data
2025
Autores
Ramalho, Sergio Henrique Rodolpho
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: Nas últimas décadas, avanços no diagnóstico e tratamento precoce do câncer melhoraram significativamente os desfechos clínicos, aumentando a expectativa de vida dos sobreviventes. Com isso, cresce também o risco de desenvolver outras doenças crônicas precocemente, como as cardiovasculares. Adicionalmente, tratamentos específicos como radio ou quimioterapia, ou novas drogas imunobiológicas, podem aumentar o risco de eventos cardiovasculares tanto durante o tratamento quanto na fase de sobrevivência. Acredita-se que esse aumento da morbidade cardiovascular seja dose-dependente, causado tanto por lesões diretas no cardiomiócito ou endotélio, como por efeitos indiretos em fatores de risco, como aumento da prevalência de hipertensão, “dismetabolismo” ou sedentarismo. Especificamente para seminomas testiculares, essa correlação tem dois agravantes: a idade precoce de acometimento e o tratamento à base de platinas. É a neoplasia mais comum em homens entre 20 e 40 anos e seu tratamento quimioterápico é a base de platinas, combinado com bleomicina e etoposídeo, o que permite a cura da maioria dos pacientes. No entanto, esse tratamento está associado a um maior risco de doença coronariana e fenômenos tromboembólicos. Objetivos: Descrever um caso clinico de seminoma testicular, abordando as implicações cardiovasculares do tratamento e da própria doença. Realizar uma revisão narrativa da literatura sobre o risco cardiovascular envolvido com o seminoma testicular, tanto na fase de tratamento e doença aguda quanto em relação aos sobreviventes e o risco em longo prazo. Método: Trata-se de um estudo de caso, complementado por uma revisão narrativa da literatura. Os dados do caso clínico foram coletados a partir do prontuário do paciente e de meu acompanhamento, mediante autorização do paciente. A revisão da literatura foi realizada utilizando bases de dados eletrônicas (PubMed, Scielo), com foco em artigos que abordassem a relação entre seminoma testicular, seu tratamento e o risco cardiovascular, tanto na fase aguda quanto em longo prazo. Foram utilizados termos de busca como "seminoma testicular", "risco cardiovascular", "quimioterapia", "cisplatina", "cardiotoxicidade" e "sobreviventes de câncer". Resultados: O caso clínico relatado demonstra a ocorrência de eventos cardiovasculares tardios e graves em um paciente com seminoma testicular submetido a tratamento com quimioterapia à base de platina. A revisão da literatura reforça que a quimioterapia com platina e combinações está associada a disfunção endotelial, aterosclerose acelerada, hipertensão, dislipidemia e aumento do risco de infarto do miocárdio e eventos tromboembólicos. Tais eventos têm distribuição bimodal: são mais frequentes no primeiro ano após o tratamento e após 10 anos de remissão da doença. Sobreviventes de seminoma testicular apresentam um risco aumentado de mortalidade por doença cardiovascular em comparação com a população geral. Estudos com fármacos com menos efeitos adversos ainda são escassos. Conclusões: Pacientes com seminoma testicular, especialmente aqueles submetidos a quimioterapia com platinas, apresentam um risco aumentado de eventos cardiovasculares. Entretanto essa associação precisa ser estudada em tempos contemporâneos, com esquemas mais modernos e potencialmente menos tóxicos. É fundamental a vigilância cardiológica contínua desses pacientes, tanto durante o tratamento quanto no seguimento em longo prazo, com manejo agressivo dos fatores de risco cardiovasculares tradicionais e consideração de abordagens terapêuticas que minimizem as lesões cardiovasculares clínicas e subclínicas.
Introduction: In recent decades, advances in cancer diagnosis and early treatment have significantly improved clinical outcomes, increasing the life expectancy of survivors. Consequently, there is also a growing risk of developing other chronic diseases prematurely, such as cardiovascular diseases. Additionally, specific treatments like radio- or chemotherapy, or new immunobiological drugs, can increase the risk of cardiovascular events both during treatment and in the survival phase. This increase in cardiovascular morbidity is believed to be dose-dependent, caused by both direct damage to cardiomyocytes or the endothelium, as well as by indirect effects on risk factors such as an increased prevalence of hypertension, dysmetabolism, or sedentary lifestyle. Specifically for testicular seminomas, this correlation has two aggravating factors: the early age of onset and platinum-based treatment. As the most common malignancy in men aged 20 to 40, platinum-based chemotherapy, combined with bleomycin and etoposide, allows for the cure of most patients. However, this treatment is associated with a higher risk of coronary artery disease and thromboembolic phenomena. Objectives: To describe a clinical case of testicular seminoma, addressing the cardiovascular implications of the treatment and the disease itself. To conduct a narrative review of the medical literature on the cardiovascular risk involved with testicular seminoma, both in the acute treatment and disease phase, and in relation to long-term survivors and long-term risk. Method: This is a case study, complemented by a narrative literature review. The clinical case data were collected from the patient's medical record and my follow-up, with patient authorization. The literature review was performed using electronic databases (PubMed, SciELO), focusing on articles that addressed the relationship between testicular seminoma, its treatment, and cardiovascular risk, both in the acute and long-term phases. Search terms used included "testicular seminoma," "cardiovascular risk," "chemotherapy," "cisplatin," "cardiotoxicity," and "cancer survivors." Results: The reported clinical case demonstrates the occurrence of late and severe cardiovascular events in a patient with testicular seminoma who underwent platinumbased chemotherapy. The literature review reinforces that platinum-based chemotherapy and combinations are associated with endothelial dysfunction, accelerated atherosclerosis, hypertension, dyslipidemia, and an increased risk of myocardial infarction and thromboembolic events. Such events have a bimodal distribution: they are more frequent in the first year after treatment and after 10 years of disease remission. Testicular seminoma survivors present an increased risk of cardiovascular disease mortality compared to the general population. However, studies with more modern drugs are still scarce. Conclusions: Patients with testicular seminoma, especially those undergoing platinum-based chemotherapy, present an increased risk of cardiovascular events. Nevertheless, this association needs to be studied in contemporary times, with more modern and potentially less toxic regimens. Continuous cardiological surveillance of these patients is fundamental, both during treatment and long-term follow-up, with aggressive management of traditional cardiovascular risk factors and consideration of therapeutic approaches that minimize clinical and subclinical cardiovascular damage.
Introduction: In recent decades, advances in cancer diagnosis and early treatment have significantly improved clinical outcomes, increasing the life expectancy of survivors. Consequently, there is also a growing risk of developing other chronic diseases prematurely, such as cardiovascular diseases. Additionally, specific treatments like radio- or chemotherapy, or new immunobiological drugs, can increase the risk of cardiovascular events both during treatment and in the survival phase. This increase in cardiovascular morbidity is believed to be dose-dependent, caused by both direct damage to cardiomyocytes or the endothelium, as well as by indirect effects on risk factors such as an increased prevalence of hypertension, dysmetabolism, or sedentary lifestyle. Specifically for testicular seminomas, this correlation has two aggravating factors: the early age of onset and platinum-based treatment. As the most common malignancy in men aged 20 to 40, platinum-based chemotherapy, combined with bleomycin and etoposide, allows for the cure of most patients. However, this treatment is associated with a higher risk of coronary artery disease and thromboembolic phenomena. Objectives: To describe a clinical case of testicular seminoma, addressing the cardiovascular implications of the treatment and the disease itself. To conduct a narrative review of the medical literature on the cardiovascular risk involved with testicular seminoma, both in the acute treatment and disease phase, and in relation to long-term survivors and long-term risk. Method: This is a case study, complemented by a narrative literature review. The clinical case data were collected from the patient's medical record and my follow-up, with patient authorization. The literature review was performed using electronic databases (PubMed, SciELO), focusing on articles that addressed the relationship between testicular seminoma, its treatment, and cardiovascular risk, both in the acute and long-term phases. Search terms used included "testicular seminoma," "cardiovascular risk," "chemotherapy," "cisplatin," "cardiotoxicity," and "cancer survivors." Results: The reported clinical case demonstrates the occurrence of late and severe cardiovascular events in a patient with testicular seminoma who underwent platinumbased chemotherapy. The literature review reinforces that platinum-based chemotherapy and combinations are associated with endothelial dysfunction, accelerated atherosclerosis, hypertension, dyslipidemia, and an increased risk of myocardial infarction and thromboembolic events. Such events have a bimodal distribution: they are more frequent in the first year after treatment and after 10 years of disease remission. Testicular seminoma survivors present an increased risk of cardiovascular disease mortality compared to the general population. However, studies with more modern drugs are still scarce. Conclusions: Patients with testicular seminoma, especially those undergoing platinum-based chemotherapy, present an increased risk of cardiovascular events. Nevertheless, this association needs to be studied in contemporary times, with more modern and potentially less toxic regimens. Continuous cardiological surveillance of these patients is fundamental, both during treatment and long-term follow-up, with aggressive management of traditional cardiovascular risk factors and consideration of therapeutic approaches that minimize clinical and subclinical cardiovascular damage.
Description
Palavras-chave
Seminoma testicular, risco cardiovascular, cardiotoxicidade, disfunção endotelial, Cisplatina, Carboplatina, sobreviventes de câncer, testicular seminoma, cardiovascular risk, cardiotoxicity, endothelial dysfunction Cisplatin, Carboplatin, cancer survivors.
Citação
Ramalho SHR. Sobrevivendo ao câncer - seminoma testicular e seu tratamento devem ser tratados como fatores de risco cardiovascular? : estudo de caso e revisão narrativa da literatura. Rio de Janeiro. Trabalho de conclusão de curso [Programa de Pós-Graduação em Cardio-Oncologia]. Instituto Nacional de Cardiologia; 2025.