Brydøy Marianne, Fosså Sophie D, Dahl Olav, Bjøro Trine
Department of Oncology, Haukeland University Hospital, Bergen, Norway.
Acta Oncol. 2007;46(4):480-9. doi: 10.1080/02841860601166958.
Gonadal dysfunction and fertility problems are adverse effects of cancer treatment or may be associated with specific malignancies. This review focuses on these problems in the young cancer survivors, where methods of protecting or restoring endocrine function and fertility need to be considered. In females, treatment adverse effects can result in infertility, but premature ovarian failure (POF) is probably relevant for more female cancer survivors, affecting also those who do not wish post-treatment parenthood. POF affects present and future health, especially through oestrogen deficiency symptoms and an increased risk of developing osteoporosis. A lower risk of developing POF has been considered in young females than in older due to a larger pool of oocytes. However, a recent long-term follow-up study reported a prevalence of POF in young females with Hodgkin's lymphoma of 37% showing that young age at time of treatment only delays the development of POF. In male gonads, germ cells are much more sensitive to irradiation and chemotherapy than Leydig cells. Thus, infertility is a more common adverse effect than hypogonadism. Some malignancies are particular relevant. Persistent azoospermia was formerly common after treatment for Hodgkin's lymphoma, but currently, most patients recover spermatogenesis. Modern treatment of childhood acute lymphoblastic leukemia is also unlikely to cause infertility. Norwegian testicular cancer survivors diagnosed in 1980-1994 who attempted conception had an overall 15-year actuarial post-treatment paternity rate of 71% (range 48-92% depending on the treatment). However, the rate was significantly higher among men diagnosed in1989-1994 (over 80%) than in 1980-1988 (about 63%). Patients at risk for hypogonadism and infertility should be defined prior to treatment, and available methods for gonadal preservation should maximally be utilised. During follow-up, oncologists should routinely address these issues.
性腺功能障碍和生育问题是癌症治疗的不良反应，或可能与特定恶性肿瘤相关。本综述聚焦于年轻癌症幸存者中的这些问题，其中需要考虑保护或恢复内分泌功能及生育能力的方法。在女性中，治疗不良反应可导致不孕，但卵巢早衰（POF）可能与更多女性癌症幸存者相关，也会影响那些不希望治疗后生育的女性。卵巢早衰会影响当前和未来的健康，尤其是通过雌激素缺乏症状以及患骨质疏松症风险的增加。由于年轻女性的卵母细胞库更大，因此人们认为其发生卵巢早衰的风险低于年长女性。然而，最近一项长期随访研究报告称，患有霍奇金淋巴瘤的年轻女性中卵巢早衰的患病率为37%，这表明治疗时的年轻年龄仅会延迟卵巢早衰的发生。在男性性腺中，生殖细胞比睾丸间质细胞对辐射和化疗更为敏感。因此，不孕是比性腺功能减退更常见的不良反应。某些恶性肿瘤尤为相关。以前，霍奇金淋巴瘤治疗后持续性无精子症很常见，但目前，大多数患者可恢复精子发生。儿童急性淋巴细胞白血病的现代治疗也不太可能导致不孕。1980 - 1994年被诊断为睾丸癌的挪威幸存者尝试受孕，其治疗后15年的总体精算生育率为71%（范围为48% - 92%，取决于治疗方式）。然而，1989 - 1994年被诊断的男性（超过80%）的生育率显著高于1980 - 1988年（约63%）。对于有性腺功能减退和不孕风险的患者，应在治疗前确定，并应最大限度地利用现有的性腺保护方法。在随访期间，肿瘤学家应常规处理这些问题。
