Meistrich M L, Chawla S P, Da Cunha M F, Johnson S L, Plager C, Papadopoulos N E, Lipshultz L I, Benjamin R S
Department of Experimental Radiotherapy, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston 77030.
Cancer. 1989 Jun 1;63(11):2115-23. doi: 10.1002/1097-0142(19890601)63:11<2115::aid-cncr2820631108>3.0.co;2-a.
Because treatment with surgery and combination chemotherapy produces a high cure rate in young men with osteosarcoma, their subsequent reproductive function is an important concern. Semen analyses of osteosarcoma patients, therefore, were performed before, during, and after treatment with the PADIC regimen consisting of cisplatin, Adriamycin (doxorubicin), and dacarbazine or, in some cases, the PADIC regimen plus additional drugs. Results showed that semen volume was not affected and that sperm motility was reduced only during treatment. Although nearly all patients were rendered azoospermic during treatment, sperm production resumed in 30 of 32 patients examined at least 2 years after treatment. Analysis with correction for censored data indicates that, in 78% of treated men, sperm counts will return to more than 10 million/ml. The percentage of men whose sperm counts recovered to normal was lower for those receiving cisplatin dosages greater than or equal to 600 mg/m2; no trends were observed with Adriamycin and dacarbazine dosages. The inclusion of additional drugs such as methotrexate, bleomycin, dactinomycin, or cyclophosphamide (less than 4 g/m2) did not significantly affect the recovery of spermatogenesis. We conclude that the risk of long-term infertility from treatment with the PADIC regimen is low.
由于手术和联合化疗能使患有骨肉瘤的年轻男性获得较高的治愈率，因此他们后续的生殖功能成为一个重要问题。于是，对骨肉瘤患者在使用由顺铂、阿霉素（多柔比星）和达卡巴嗪组成的PADIC方案治疗前、治疗期间及治疗后，以及在某些情况下使用PADIC方案加用其他药物时进行了精液分析。结果显示精液量未受影响，且仅在治疗期间精子活力降低。尽管几乎所有患者在治疗期间都出现无精子症，但在治疗后至少2年接受检查的32例患者中有30例恢复了精子生成。对删失数据进行校正后的分析表明，在78%接受治疗的男性中，精子计数将恢复到超过1000万/毫升。对于接受顺铂剂量大于或等于600毫克/平方米的男性，精子计数恢复到正常的百分比更低；未观察到阿霉素和达卡巴嗪剂量与精子计数恢复之间的趋势。加用甲氨蝶呤、博来霉素、放线菌素或环磷酰胺（小于4克/平方米）等其他药物对精子发生的恢复没有显著影响。我们得出结论，使用PADIC方案治疗导致长期不育的风险较低。
