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Abstract
A standard curative intent approach of chemotherapy treatment for metastatic testicular cancer has been well established. However, there is little guidance for patients undergoing hemodialysis (HD) who require chemotherapy for this disease. Thus, we describe our treatment approach and rationale for a patient on HD with poor risk metastatic nonseminomatous germ cell tumor involving the testicle, lymph nodes, liver, and bone. After orchiectomy, five cycles of cisplatin and modified dose etoposide were delivered and strategically timed with HD. Treatment was complicated by significant neuropathy. Surgical resection of two liver lesions was performed after chemotherapy. Ten years post-chemotherapy, he remains free of clinical, biochemical, or radiological recurrence. While our patient remains free of disease after this treatment, the optimal chemotherapy and dialysis dose and schedule to maximize cure and minimize toxicity remains unknown.
Highlights
The goal of treatment for patients with metastatic testicular cancer is cure
We present a case of a patient with poor risk nonseminomatous germ cell tumour in the setting of chronic renal failure who was being worked up for a renal transplant
Very little literature has been published on the safe and effective delivery of chemotherapy in this subset of patients; this case report provides an important addition to medical literature
Summary
The goal of treatment for patients with metastatic testicular cancer is cure. The standard chemotherapy for treatment of poor risk patients is four cycles of bleomycin, etoposide, and cisplatin (BEP) or etoposide, ifosfamide, and cisplatin (VIP) [1]. For testicular cancer patients with renal impairment requiring hemodialysis (HD), the optimal delivery and efficacy of chemotherapy is a rare and challenging clinical scenario. We present a case of a patient with poor risk nonseminomatous germ cell tumour in the setting of chronic renal failure who was being worked up for a renal transplant. Very little literature has been published on the safe and effective delivery of chemotherapy in this subset of patients; this case report provides an important addition to medical literature
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