Anderson Katherine H, Romao Rodrigo L P
Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada.
Transl Androl Urol. 2020 Oct;9(5):2393-2399. doi: 10.21037/tau-19-923.
The treatment modalities for testicular tumors (surgery, chemotherapy, and radiotherapy), have different associated gonadotoxic risks and the overall survival for most pediatric patients with testicular tumors is very good. However, necessary treatments may lead to the development of lasting gonadal dysfunction and subsequent negative health and quality of life impact. Research with long-term follow-up for patients who have undergone surgery as the sole treatment modality for testicular tumors in childhood are lacking. It is currently unclear if surgery leads to long-term negative functional outcomes. Alkylating agents (e.g., cyclophosphamide) have long been known to increase risk of infertility; platinum-based therapies used frequently for patients with germ-cell tumors (GCTs) also seem to carry some risk of gonadotoxicity, although they have not been as well studied. Radiotherapy to the gonads is toxic and Leydig cells are particularly sensitive to high doses of radiation (>12 Gy). Long-term fertility and hormonal impact vary based on the patient's age, as well as the type and intensity of the oncological treatment prescribed. Counselling regarding fertility risk and preservation options should ideally take place before initiating potentially gonadotoxic treatments. Hypogonadism in peri-pubertal boys can present as delayed onset or failure to progress through puberty. Sperm cryopreservation should be offered for post-pubertal boys who are able to provide a semen sample. For prepubertal boys or young males who cannot provide a semen sample, only experimental options are currently available. Much of the data reviewed here is extrapolated from research done on adult males whose reproductive and hormonal outcomes may not be comparable to younger patients who do not yet have fully developed reproductive systems. Currently, a lack of good quality evidence in this age range causes this restriction to be unavoidable. Patients and their families want to be informed of the risks and treatment options for preserving testicular function. As research continues in this field, it grows more important for urologists to be aware of the outcomes and options for their patients.
睾丸肿瘤的治疗方式（手术、化疗和放疗）具有不同的相关性腺毒性风险，大多数小儿睾丸肿瘤患者的总体生存率非常高。然而，必要的治疗可能会导致持续性性腺功能障碍的发生，并对健康和生活质量产生后续负面影响。目前缺乏对童年期仅接受手术作为睾丸肿瘤治疗方式的患者进行长期随访的研究。目前尚不清楚手术是否会导致长期的负面功能结局。长期以来，人们已知烷化剂（如环磷酰胺）会增加不育风险；常用于生殖细胞肿瘤（GCT）患者的铂类疗法似乎也存在一定的性腺毒性风险，尽管对其研究尚不充分。性腺放疗具有毒性，睾丸间质细胞对高剂量辐射（>12 Gy）尤为敏感。长期生育能力和激素影响因患者年龄以及所规定的肿瘤治疗类型和强度而异。理想情况下，应在开始可能具有性腺毒性的治疗之前，就生育风险和保存方案进行咨询。青春期前男孩的性腺功能减退可能表现为青春期延迟开始或发育停滞。对于能够提供精液样本的青春期后男孩，应提供精子冷冻保存。对于无法提供精液样本的青春期前男孩或年轻男性，目前只有实验性选择。此处回顾的许多数据是从对成年男性的研究中推断出来的，其生殖和激素结局可能与生殖系统尚未完全发育的年轻患者不可比。目前，这个年龄范围内缺乏高质量证据使得这种限制不可避免。患者及其家属希望了解保留睾丸功能的风险和治疗选择。随着该领域研究的不断深入，泌尿外科医生了解其患者的结局和选择变得越发重要。
