Michalczyk Kaja, Cymbaluk-Płoska Aneta
Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
Cancers (Basel). 2021 Jan 8;13(2):202. doi: 10.3390/cancers13020202.
Chemo- and radio-therapy can often affect reproductive organs impairing hormonal regulation, fertility, and sexual function. As cancer treatments become more effective and many patients have long term survival, concerns related to patient's quality of life and reproductive health become relevant. It is especially important for girls and young females facing cancer therapy who have not yet started family planning. Chemotherapy protocols using alkylating agents and abdominal radiotherapy, which are frequently used in the treatment of childhood and adolescent cancer, can cause gonadal injury. The most common clinical manifests are ovarian hormone insufficiency, premature ovarian insufficiency, early menopause and infertility. In this review we assess current literature and summarize current recommendations on the reproductive function of girls and young females undergoing cancer treatment and their follow-up. Fertility preservation methods are discussed, including psychological and ethical considerations and barriers. Improvement of reproductive health and quality of life of adolescents and young adults (AYA) undergoing cancer treatment is an important issue. Further research should be continued to develop efficient and accessible methods for fertility preservation in young patients. An expert panel including oncologists, radiation oncologists, endocrinologists and gynecologists should always consider fertility preservation in pediatric, adolescent and AYA cancer patients, minding patients' medical condition, cancer staging and potential risk of treatment-related gonadotoxicity.
化疗和放疗常常会影响生殖器官，损害激素调节、生育能力和性功能。随着癌症治疗变得更加有效且许多患者实现长期生存，与患者生活质量和生殖健康相关的问题变得愈发重要。对于尚未开始计划生育的面临癌症治疗的女孩和年轻女性而言，这一点尤为重要。常用于治疗儿童和青少年癌症的使用烷化剂的化疗方案和腹部放疗会导致性腺损伤。最常见的临床表现为卵巢激素不足、卵巢早衰、过早绝经和不孕。在本综述中，我们评估了当前的文献，并总结了关于接受癌症治疗的女孩和年轻女性的生殖功能及其随访的当前建议。我们讨论了生育力保存方法，包括心理和伦理方面的考虑因素及障碍。改善接受癌症治疗的青少年和青年（AYA）的生殖健康和生活质量是一个重要问题。应继续开展进一步研究，以开发针对年轻患者有效且可及的生育力保存方法。包括肿瘤学家、放射肿瘤学家、内分泌学家和妇科医生在内的专家小组应始终考虑为儿科、青少年和AYA癌症患者保存生育力，同时关注患者的病情、癌症分期以及治疗相关性腺毒性的潜在风险。
