Ortin T T, Shostak C A, Donaldson S S
Department of Radiation Oncology, Stanford University Medical Center, CA 94305.
Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):873-80. doi: 10.1016/0360-3016(90)90007-7.
To ascertain the impact of therapy on gonadal function and reproductive outcome among children treated for Hodgkin's disease, we reviewed the experience at Stanford University Medical Center during the years 1965-1986. There were 240 children 15 years of age or younger, 92 girls and 148 boys; with median follow-up of 9 years, maximum follow-up was 26 years. Of this cohort, data on gonadal function were available on 20 boys, 5 of whom were considered prepubescent; they had no clinical evidence of sexual maturation and were less than 13 years of age. Evaluation of the boys included testicular biopsy, semen analyses and the ability to procreate. Serum gonadotropin hormone levels (FSH, LH) were studied in 11 boys who also had semen analyses. Sexual maturation was attained in all boys without the need for androgen replacement. Among the eight boys treated with radiation alone, four were able to father a child (3 following 40-45 Gy pelvic radiation dose, 1 without pelvic radiation) from 3-19 years following treatment. Three others who received 30-44 Gy pelvic radiation were oligospermic when tested at 10 to 15 years post-treatment. Semen analyses in 10 of 12 (83%) boys who had been treated with six cycles of MOPP with or without pelvic radiation revealed absolute azoospermia with no evidence of recovery as along as 11 years of follow-up. Following prolonged azoospermia, 2 of the 12 boys (17%) had recovery of fertility, with normalization of sperm count and/or ability to procreate at 12 and 15 years following treatment. There was no correlation with serum gonadotropin levels and sterility. Data on menstrual history, pregnancy and offspring were available in 86 (92%) of the girls. Seventy-five of the 86 girls (87%) have normal menstrual function. However, none of the females who underwent pelvic radiation without prior oophoropexy has maintained ovarian function. Both the prepubescent and postpubescent boys were affected by 6 cycles of MOPP whether or not pelvic radiation was administered. On the other hand, in girls similarly treated, ovarian injury was directly related to both the number of cycles of chemotherapy and the ovarian radiation dose. The chances of maintaining gonadal function following combined modality treatment are significantly greater among girls than boys. The progeny of patients treated for Hodgkin's disease appear normal and no excess fetal wastage has been noted.
为确定治疗对霍奇金病患儿性腺功能及生殖结局的影响，我们回顾了斯坦福大学医学中心1965年至1986年间的经验。共有240名15岁及以下儿童，其中女孩92名，男孩148名；中位随访时间为9年，最长随访时间为26年。在这一队列中，有20名男孩可获得性腺功能数据，其中5名被认为是青春期前儿童；他们没有性成熟的临床证据，年龄小于13岁。对男孩的评估包括睾丸活检、精液分析及生育能力。对11名同时进行了精液分析的男孩研究了血清促性腺激素水平（FSH、LH）。所有男孩均实现了性成熟，无需雄激素替代治疗。在仅接受放疗的8名男孩中，4名在治疗后3至19年能够生育（3名在盆腔放疗剂量为40 - 45 Gy后，1名未接受盆腔放疗）。另外3名接受30 - 44 Gy盆腔放疗的男孩在治疗后10至15年检测时为少精子症。在接受6周期MOPP方案治疗（无论是否联合盆腔放疗）的12名男孩中，10名（83%）的精液分析显示为绝对无精子症，长达11年的随访中无恢复迹象。在长期无精子症后，12名男孩中有2名（17%）恢复了生育能力，在治疗后12年和15年精子计数及/或生育能力恢复正常。血清促性腺激素水平与不育症之间无相关性。86名（92%）女孩可获得月经史、妊娠及后代的数据。86名女孩中有75名（87%）月经功能正常。然而，所有未预先进行卵巢固定术而接受盆腔放疗的女性均未维持卵巢功能。无论是否进行盆腔放疗，青春期前和青春期后的男孩均受到6周期MOPP方案的影响。另一方面，在接受类似治疗的女孩中，卵巢损伤与化疗周期数及卵巢放疗剂量均直接相关。联合治疗后女孩维持性腺功能的几率显著高于男孩。霍奇金病治疗患者的后代看起来正常，未发现胎儿过度流失的情况。
