Aubier F, Flamant F, Brauner R, Caillaud J M, Chaussain J M, Lemerle J
Service de Pédiatrie, Institut Gustave-Roussy, Paris, France.
J Clin Oncol. 1989 Mar;7(3):304-9. doi: 10.1200/JCO.1989.7.3.304.
The testicular function of 30 adolescent or adult males having undergone polychemotherapy in childhood was assessed by means of a spermogram or testicular biopsy. At the time of examination, the patients were pubertal and had completed chemotherapy between 1 and 20 years previously (mean, 9 years). All patients who were prepubertal or intrapubertal at the time of treatment achieved normal puberty with normal growth. Twenty patients presented with azoospermia and/or severe disturbances in the germinal line on biopsy. This series confirms the toxicity of alkylating agents, in particular that of the mechlorethamine, vincristine, procarbazine, and prednisone combination (MOPP) and that of cyclophosphamide (CPM). However, dactinomycin, vinblastine, and vincristine did not appear to have a toxic effect on spermatogenesis. The prepubertal state did not protect the gonads of 19 patients who were prepubertal at diagnosis: 12 are now sterile as a result of the treatment. An increase in basal follicle-stimulating hormone (FSH) levels gives a good indication of testicular damage, although normal levels do not rule out the possibility of azoospermia.
通过精液分析或睾丸活检对30名童年期接受过多种化疗的青少年或成年男性的睾丸功能进行了评估。在检查时，这些患者已进入青春期，且在1至20年前（平均9年）完成了化疗。所有在治疗时处于青春期前或青春期的患者均实现了正常的青春期发育和正常生长。20例患者活检显示无精子症和/或生精细胞严重紊乱。该系列研究证实了烷化剂的毒性，尤其是氮芥、长春新碱、丙卡巴肼和泼尼松联合方案（MOPP）以及环磷酰胺（CPM）的毒性。然而，放线菌素D、长春碱和长春新碱似乎对精子发生没有毒性作用。诊断时处于青春期前状态并不能保护19名青春期前患者的性腺：其中12例因治疗而不育。基础促卵泡激素（FSH）水平升高很好地表明了睾丸受损，尽管FSH水平正常也不能排除无精子症的可能性。
