Kutluk Oktay and Hugh S. Taylor, Yale University School of Medicine, New Haven, CT; Brittany E. Harvey, American Society of Clinical Oncology, Alexandria, VA; Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Gwendolyn P. Quinn, New York University School of Medicine, New York, NY; Joyce Reinecke, Alliance for Fertility Preservation, Lafayette; Erica T. Wang, Cedars-Sinai Medical Center, Los Angeles, CA; W. Hamish Wallace, The Hospital for Sick Children, Edinburgh, United Kingdom; Alison W. Loren, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
J Clin Oncol. 2018 Jul 1;36(19):1994-2001. doi: 10.1200/JCO.2018.78.1914. Epub 2018 Apr 5.
Purpose To provide current recommendations about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from January 2013 to March 2017 was completed using PubMed and the Cochrane Library. An Update Panel reviewed the identified publications. Results There were 61 publications identified and reviewed. None of these publications prompted a significant change in the 2013 recommendations. Recommendations Health care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible. Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm, oocyte, and embryo cryopreservation are considered standard practice and are widely available. There is conflicting evidence to recommend gonadotrophin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation. The Panel recognizes that, when proven fertility preservation methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. GnRHa should not be used in place of proven fertility preservation methods. The panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future. Additional information is available at www.asco.org/survivorship-guidelines .
为癌症成人和儿童提供生育力保存的当前建议。
使用 PubMed 和 Cochrane 图书馆对 2013 年 1 月至 2017 年 3 月发表的文献进行了系统评价。更新小组审查了已确定的出版物。
共确定并审查了 61 篇出版物。这些出版物中没有一篇对 2013 年的建议提出重大改变。
医护人员应尽早与接受生殖年龄癌症治疗的患者或儿童的父母/监护人开始讨论不孕的可能性。医护人员应准备讨论生育力保存方案，并/或将所有潜在患者转介给适当的生殖专家。尽管患者最初可能专注于癌症诊断，但医护人员应在治疗过程中尽早告知患者潜在的生育威胁，以便为生育力保存提供最多的选择。讨论应记录在案。精子、卵子和胚胎冷冻保存被认为是标准做法，并且广泛可用。有证据表明促性腺激素释放激素激动剂（GnRHa）和其他卵巢抑制方法可用于生育力保存，但证据相互矛盾。专家组认识到，在可行的生育力保存方法不可行的情况下，并且在年轻的乳腺癌女性中，可以向患者提供 GnRHa，以期降低化疗引起的卵巢功能不全的可能性。不应将 GnRHa 用作可行的生育力保存方法的替代品。专家组注意到，卵巢组织冷冻保存领域正在迅速发展，并可能在未来发展成为标准疗法。更多信息请访问 www.asco.org/survivorship-guidelines。
