Papadakis V, Vlachopapadopoulou E, Van Syckle K, Ganshaw L, Kalmanti M, Tan C, Sklar C
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Med Pediatr Oncol. 1999 May;32(5):366-72. doi: 10.1002/(sici)1096-911x(199905)32:5<366::aid-mpo10>3.0.co;2-7.
Gonadal function in pediatric and young adult survivors of Hodgkin disease is not very well defined. This study evaluates the outcome following the Multiple Drug Protocol (MDP) and the results are compared to the published experience.
Ovarian and testicular function was assessed in 65 patients (36 males) with Hodgkin disease in first or second complete remission after treatment with either radiation (RT, n = 13), chemotherapy (CT, n = 9), or both (n = 43). Chemotherapy consisted of six cycles of the MDP (doxorubicin, procarbazine, prednisone, vincristine, and cyclophosphamide). Median age at diagnosis was 13.1 years (range, 2.4-22.6) and median age at evaluation was 22.6 years (range, 15.1-33.7), which was 6.7 years (range, 2.0-19.8) after the completion of all treatments. For the purpose of analysis, patients were divided into three groups: group A, patients who received only RT that did not include the pelvis (8 females, 5 males); group B, patients who received CT but no pelvic RT (15 females, 25 males); and group C, patients who received CT plus pelvic RT (6 females, 6 males).
All patients progressed spontaneously through puberty and evaluable patients were found to be sexually mature (Tanner stage IV and V). Serum follicle stimulating hormone (FSH) was increased in 0/5, 13/25, and 5/6 and testicular volume was decreased in 1/3, 4/11, and 2/3 group A, B, and C male patients, respectively. Leydig cell dysfunction was uncommon; 91% and 88% of males had normal serum concentrations of luteinizing hormone (LH) and testosterone, respectively. FSH and LH were increased in 0/8, 3/15, and 2/6 group A, B, and C female patients, respectively, at last follow-up, indicating a 17% prevalence of ovarian dysfunction. Serial data in seven females whose initial levels of FSH/LH were elevated revealed normalization in four. Six females delivered eight normal children.
The majority of males who received CT +/- RT have evidence of germ cell dysfunction, while Leydig cell function is unaffected in most. In females, although abnormal function early after the end of treatment was observed, ovarian function remained or returned to normal in most young women. Thus, in females the results of hormone testing performed early after treatment may not be predictive of their eventual reproductive potential.
霍奇金病儿科及年轻成人幸存者的性腺功能尚未完全明确。本研究评估了多药方案（MDP）的治疗结果，并将结果与已发表的经验进行比较。
对65例霍奇金病患者（36例男性）的卵巢和睾丸功能进行评估，这些患者在接受放疗（RT，n = 13）、化疗（CT，n = 9）或两者联合治疗（n = 43）后处于首次或第二次完全缓解期。化疗包括六个周期的MDP（多柔比星、丙卡巴肼、泼尼松、长春新碱和环磷酰胺）。诊断时的中位年龄为13.1岁（范围2.4 - 22.6岁），评估时的中位年龄为22.6岁（范围15.1 - 33.7岁），在所有治疗结束后为6.7岁（范围2.0 - 19.8岁）。为了分析，患者被分为三组：A组，仅接受不包括盆腔的放疗的患者（8例女性，5例男性）；B组，接受化疗但未进行盆腔放疗的患者（15例女性，25例男性）；C组，接受化疗加盆腔放疗的患者（6例女性，6例男性）。
所有患者均自然进入青春期，可评估的患者性成熟（ Tanner分期IV和V期）。A组、B组和C组男性患者中，血清卵泡刺激素（FSH）升高的比例分别为0/5、13/25和5/6，睾丸体积减小的比例分别为1/3、4/11和2/3。睾丸间质细胞功能障碍不常见；分别有91%和88%的男性血清黄体生成素（LH）和睾酮浓度正常。在最后一次随访时，A组、B组和C组女性患者中FSH和LH升高的比例分别为0/8、3/15和2/6，表明卵巢功能障碍的患病率为17%。对7名初始FSH/LH水平升高的女性进行的系列数据显示，4名恢复正常。6名女性分娩了8名健康儿童。
大多数接受CT +/- RT的男性有生殖细胞功能障碍的证据，而大多数男性的睾丸间质细胞功能未受影响。在女性中，虽然在治疗结束后早期观察到功能异常，但大多数年轻女性的卵巢功能保持或恢复正常。因此，在女性中，治疗后早期进行的激素检测结果可能无法预测其最终的生殖潜能。
