de Lambert Guénolée, Poirot Catherine, Guérin Florent, Brugières Laurence, Martelli Héléne
Hôpitaux universitaires Paris-Sud, hôpital Bicêtre, service de chirurgie pédiatrique, 94275 Le Kremlin-Bicêtre, France.
CHI Poissy-St Germain, université Paris VI, unité de préservation de la fertilité, site de St Germain-en-Laye, 78100 St Germain-en-Laye, France.
Bull Cancer. 2015 May;102(5):436-42. doi: 10.1016/j.bulcan.2015.02.015. Epub 2015 Mar 24.
Preserving fertility is a requisite for any child undergoing gonadotoxic treatment for cancer. Techniques vary depending on the age, sex of the patient and nature of the treatment. Boys undergoing irradiation have testicular protection or transposition. Post-pubertal boys undergoing chemotherapy can have semen cryopreservation like adults. However, fertility preservation for pre-pubertal boys undergoing chemotherapy implies testicular tissue cryopreservation. Research concentrates on germ cell transplantation, autotransplantation of testicular tissue or in vitro spermatogonial maturation in order to later restore spermatogenesis. Ovarian transposition can be undergone in case of brachytherapy or external beam radiotherapy in girls and has published success rates of 80%. Ovarian cryopreservation has been developed since 1995 for pre-pubertal and post-pubertal girls undergoing chemotherapy. The ovary is retrieved surgically and ovarian cortical segments are frozen. Thawing and transplantation of gonadal tissue are the next steps to restoring fertility. However, immature oocytes will have to be matured either in vivo or in vitro in order to restore fertility. Fertility preservation must be offered to children with cancer even if maturation of immature germ cells is uncertain for research 20 to 30 years from now will probably enable fertility restoration.
对于任何接受癌症性腺毒性治疗的儿童来说，保留生育能力都是必要的。技术因患者的年龄、性别以及治疗性质而异。接受放疗的男孩会进行睾丸保护或睾丸移位。青春期后的男孩接受化疗时，可以像成年人一样进行精液冷冻保存。然而，青春期前接受化疗的男孩保留生育能力意味着要进行睾丸组织冷冻保存。研究集中在生殖细胞移植、睾丸组织自体移植或体外精原细胞成熟，以便日后恢复精子生成。女孩在近距离放疗或外照射放疗时可进行卵巢移位，已公布的成功率为80%。自1995年以来，针对接受化疗的青春期前和青春期后女孩开发了卵巢冷冻保存技术。通过手术取出卵巢，将卵巢皮质段冷冻。性腺组织的解冻和移植是恢复生育能力的后续步骤。然而，未成熟卵母细胞必须在体内或体外成熟，才能恢复生育能力。即使未成熟生殖细胞的成熟情况在未来20至30年内尚不确定，但仍必须为患癌症的儿童提供生育能力保留服务，因为届时可能实现生育能力的恢复。
