Lambertini Matteo, Del Mastro Lucia, Pescio Maria C, Andersen Claus Y, Azim Hatem A, Peccatori Fedro A, Costa Mauro, Revelli Alberto, Salvagno Francesca, Gennari Alessandra, Ubaldi Filippo M, La Sala Giovanni B, De Stefano Cristofaro, Wallace W Hamish, Partridge Ann H, Anserini Paola
Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Genoa, Italy.
Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Genoa, Italy.
BMC Med. 2016 Jan 4;14:1. doi: 10.1186/s12916-015-0545-7.
In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians.In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of "cancer and fertility preservation". A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation.Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.
在过去几年中，由于癌症患者预后情况的改善，人们对生育问题的关注日益增加。癌症患者生育力保存的国际指南建议，医生应尽早与所有育龄患者讨论其因疾病和/或治疗导致不孕的风险，以及他们在癌症后生育子女的意愿，并协助他们做出明智的生育力保存决定。根据美国临床肿瘤学会和欧洲医学肿瘤学会的建议，精子冷冻保存和胚胎/卵母细胞冷冻保存分别是男性和女性患者生育力保存的标准策略；其他策略（如性腺的药物保护和性腺组织冷冻保存）被视为实验技术。然而，从那时起，出现了新的数据，该领域的几个问题仍存在争议，患者及其主治医生都应予以关注。2015年4月，来自欧洲几个国家的癌症患者生育力保存领域的专家受邀前往热那亚（意大利）参加关于“癌症与生育力保存”主题的研讨会。会议共讨论了十个有争议的问题。专家们被要求对这些主题发表的文献进行最新综述，并鼓励他们展示自己未发表的数据。根据所展示的数据以及受邀演讲者的专业知识，共讨论并制定了十条建议，旨在帮助医生为有生育力保存意愿的年轻患者提供咨询。尽管该领域受到广泛关注，但由于缺乏关于这些主题的大型前瞻性队列研究和随机试验，大多数建议的证据水平不高于3级，这凸显了在该领域许多方面需要进一步开展研究工作。参与正在进行的登记研究和前瞻性研究对于获取更有力的信息以提供基于证据的建议至关重要。
