Byrne Julianne, Fears Thomas R, Mills James L, Zeltzer Lonnie K, Sklar Charles, Meadows Anna T, Reaman Gregory H, Robison Leslie L
The Children's National Medical Center, Washington, DC 20010, USA.
Pediatr Blood Cancer. 2004 Apr;42(4):364-72. doi: 10.1002/pbc.10449.
Fertility impairments among men treated during childhood for cancer are known to occur after some, but not all, types of anti-cancer therapy. This is the first study to evaluate proven fertility among adult male survivors of childhood acute lymphoblastic leukemia (ALL). In a retrospective cohort study, proven fertility (ever fathered a pregnancy) was evaluated by self-report among 213 men treated for ALL before age 18 on protocols of the Children's Cancer Group (CCG). Controls (N = 145) were drawn from among male siblings. Overall, with a proportional hazards analysis, proven fertility of male survivors was not different from that of controls (relative fertility (RF) = 0.95, 95% CI 0.63-1.43). However, married men treated before age 10 with high dose (24 cGy) cranial radiotherapy (RT), without spinal RT, had only 9% of the fertility of controls (Relative risk, RR = 0.09, 95% CI 0.01-0.82). High dose cranial RT at older ages was not associated with a statistically significant fertility deficit (RR = 0.56, 95% CI 0.25-1.28). In this first study of proven fertility among men treated for childhood leukemia, the majority of survivors showed no evidence of fertility impairment compared to controls. However, men treated at a young age with high dose cranial RT may have impaired fertility. These results suggest that further investigation of men with these treatments is needed to confirm and extend these findings.
已知部分（而非全部）抗癌治疗会导致童年期患癌男性出现生育功能受损。这是第一项评估童年期急性淋巴细胞白血病（ALL）成年男性幸存者实际生育能力的研究。在一项回顾性队列研究中，通过自我报告对213名18岁前按照儿童癌症组（CCG）方案接受ALL治疗的男性的实际生育能力（曾使配偶受孕）进行了评估。对照组（N = 145）来自男性同胞。总体而言，通过比例风险分析，男性幸存者的实际生育能力与对照组无异（相对生育力（RF）= 0.95，95%置信区间0.63 - 1.43）。然而，10岁前接受高剂量（24 cGy）全脑放疗（RT）且未接受脊髓放疗的已婚男性，其生育力仅为对照组的9%（相对风险，RR = 0.09，95%置信区间0.01 - 0.82）。年龄较大时接受高剂量全脑放疗与生育力 deficit无统计学显著关联（RR = 0.56，95%置信区间0.25 - 1.28）。在这项关于童年期白血病男性实际生育能力的首次研究中，与对照组相比，大多数幸存者未显示出生育功能受损的证据。然而，年轻时接受高剂量全脑放疗的男性可能生育力受损。这些结果表明，需要对接受这些治疗的男性进行进一步研究，以证实并扩展这些发现。
