Long-term outcome and treatment-related toxicity in patients with breast and testicular cancer

Heart muscle impairment on ultrasound is linked to the administered dose of anthracycline chemotherapy in women who have been treated for early breast cancer. That is the conclusion of the HARBOR study, a collaborative effort of the UMCG and AVL included in this thesis. The 569 participating women had been treated with radiotherapy and/or chemotherapy over five years ago. Of note, about half of the participants was overweight, a quarter had high blood pressure and/or high cholesterol, and 15% smoked – targets of interest to manage the risk of heart and blood vessel disease in these patients after cancer treatment.
In addition, this thesis contains long-term follow-up of a nationwide trial that compared high-dose to normal-dose chemotherapy in 885 women with breast cancer that had spread to four or more armpit lymph nodes. This N4+ study was conducted between 1993 and 1999 in ten Dutch hospitals. In the follow-up study, high-dose chemotherapy did not appear to improve survival. However, specifically in women with ten or more affected lymph nodes, 15% more patients were still alive twenty years after treatment with high-dose compared to normal-dose chemotherapy.
To address long term outcome in male cancer patients, this thesis also addresses adverse effects of the treatment of testicular cancer. The protein INSL3 was investigated in relation to the decreased testosterone production found in some patients. Furthermore, analysis of the genetic makeup of 375 patients provided clues why some patients with testicular cancer get heart or blood vessel disease after treatment, and others do not.