Gradishar W J, Schilsky R L
Joint Section of Hematology/Oncology, Michael Reese Hospital and Medical Center, Chicago, Illinois.
Crit Rev Oncol Hematol. 1988;8(2):153-71. doi: 10.1016/s1040-8428(88)80009-x.
Many patients with Hodgkin's disease, acute leukemia, non-Hodgkin's lymphoma, testicular cancer, and other tumors now regularly achieve sustained clinical remissions and cures. Drugs used in the treatment of cancer have profound and often lasting effects on the testis and ovary. Germ cell production and endocrine function may both be altered with the magnitude of the effect related to the age, pubertal status, and menstrual status of the patient as well as to the particular drug, dosage, or combination administered. The primary testicular lesion caused by all antitumor agents studied thus far is depletion of the germinal epithelium lining the seminiferous tubules. Combination chemotherapy regimens that include alkylating agents produce germinal aplasia and permanent infertility in the majority of patients. The risk of ovarian injury following combination chemotherapy is clearly related to the age of the patient at the time of treatment. Overall, 40 to 50% of women treated with combination chemotherapy become amenorrheic, although the frequency of amenorrhea in women older than 35 years may be as high as 90%. Interventions to protect the gonads from the effects of chemotherapy have not yet been developed; thus, male patients should be offered an opportunity to store semen prior to treatment and all patients should be counseled concerning the potential gonadal toxicity of cancer chemotherapy.
许多患有霍奇金病、急性白血病、非霍奇金淋巴瘤、睾丸癌和其他肿瘤的患者现在经常能实现持续的临床缓解和治愈。用于治疗癌症的药物对睾丸和卵巢有深远且往往持久的影响。生殖细胞生成和内分泌功能都可能发生改变，其影响程度与患者的年龄、青春期状态、月经状态以及所使用的特定药物、剂量或联合用药情况有关。迄今为止，所有研究过的抗肿瘤药物导致的主要睾丸病变是生精小管内衬的生殖上皮细胞耗竭。包含烷化剂的联合化疗方案会使大多数患者出现生精障碍和永久性不育。联合化疗后卵巢受损的风险显然与治疗时患者的年龄有关。总体而言，接受联合化疗的女性中有40%至50%会出现闭经，不过35岁以上女性的闭经发生率可能高达90%。目前尚未开发出保护性腺免受化疗影响的干预措施；因此，应在治疗前为男性患者提供储存精液的机会，并应向所有患者提供有关癌症化疗潜在性腺毒性的咨询。
