Klapouszczak Dana, Bertozzi-Salamon Anne Isabelle, Grandjean Hélène, Arnaud Catherine
Inserm U558, Faculté de Médecine, 37, allée Jules-Guesde, 31073 Toulouse Cedex.
Bull Cancer. 2007 Jul;94(7):636-46.
Recent advances in cancer therapy have improved the survival rate of infant and adolescent facing cancers. The objective of treatment is not only to cure cancer but also to limit its secondary consequences. Impaired fertility is an important sequel of numerous treatments against cancer. Therefore, efforts to maintain fertility must be a major consideration in the treatment plan. This review focuses on various options for preserving fertility in adolescents. In female patients, ovarian transposition out of the radiation field may considerably reduce the radiation received by the ovaries. The benefits of GnRH analogue are not yet clear and apoptosis inhibiting agents are unavailable. Embryo freezing is the most reliable method to preserve fertility. This method is time-intensive, requires a partner, and ovarian stimulation may not always be compatible with the need of starting treatment against cancer immediately. Oocyte cryopreservation is an experimental technique that can be used in post-pubertal patients irrespective of their marital status. The cryopreservation of mature oocytes has similar constrains as embryo freezing ; in addition the technique is not as well-established and the pregnancy rates obtained are much lower than those achieved with embryos. Freezing of immature oocytes followed by in vitro maturation in spite of its theoretical advantages is inefficient in current practice. Ovarian tissue cryopreservation offers great hope because it has the potential to preserve a large number of primordial follicles without any ovarian stimulation and preliminary trials have shown some success. For male adolescents cancer patients semen cryopreservation is a successful alternative that should be offered systematically when cancer therapies that may impair gonadal function are indicated. For prepubertal males there is presently no standardized technique for preserving fertility ; however, the development of testicular germ-cell harvest needs to be considered.
癌症治疗的最新进展提高了患有癌症的婴幼儿和青少年的存活率。治疗的目标不仅是治愈癌症，还要限制其继发后果。生育能力受损是众多抗癌治疗的一个重要后遗症。因此，在治疗方案中，维持生育能力的努力必须是一个主要考虑因素。本综述重点关注青少年保留生育能力的各种选择。对于女性患者，将卵巢移位至放疗区域之外可显著减少卵巢所接受的辐射。促性腺激素释放激素类似物的益处尚不清楚，且凋亡抑制药物尚不可用。胚胎冷冻是保留生育能力最可靠的方法。这种方法耗时，需要伴侣，而且卵巢刺激可能并不总是与立即开始抗癌治疗的需求相兼容。卵母细胞冷冻是一种可用于青春期后患者的实验技术，无论其婚姻状况如何。成熟卵母细胞的冷冻与胚胎冷冻有类似的限制；此外，该技术尚未成熟，获得的妊娠率远低于胚胎冷冻所达到的妊娠率。尽管未成熟卵母细胞冷冻随后进行体外成熟在理论上有优势，但在目前的实践中效率不高。卵巢组织冷冻带来了很大希望，因为它有可能在不进行任何卵巢刺激的情况下保存大量原始卵泡，初步试验已显示出一些成功案例。对于男性青少年癌症患者，精液冷冻是一种成功的选择，当指明可能损害性腺功能的癌症治疗方法时，应系统地提供这种选择。对于青春期前男性，目前尚无标准化的保留生育能力的技术；然而，需要考虑睾丸生殖细胞采集技术的发展。
