Ise T, Kishi K, Imashuku S, Tsukada M, Tsukimoto I, Tsujino G, Bessho F, Tanaka H, Miyazaki S, Sakurai M
Am J Pediatr Hematol Oncol. 1986 Winter;8(4):288-93. doi: 10.1097/00043426-198624000-00004.
Wedge biopsy of the testis was performed in 46 children who had received long-term chemotherapy for acute lymphoblastic leukemia. Occult testicular infiltration was noted in three children (6.5%). Two of three children with biopsy-proven infiltration died of systemic disease in spite of local irradiation and reinduction chemotherapy. Six of 43 children shown to be negative by testicular biopsy relapsed 11 months to 15 years later, and 3 of 6 patients died of systemic disease, but none of the cases developed testicular disease. Chemotherapy-induced gonadal damage was observed in 30 of 46 children, and tubular damage was occasionally still seen 4 years after cessation of treatment. Although gonadal damage usually depends on the cumulative dosage of cyclophosphamide, intact tubular fertility index was found in several children who had received a greater dose of cyclophosphamide intermittently. Induction and maintenance chemotherapy for acute lymphoblastic leukemia had little influence on hormonal function. Testicular biopsy at the time of cessation of chemotherapy seems to be worthwhile for the subsequent strategy of treatment, and long-term surveillance for gonadal damage of long-term survivors will be required.
对46名因急性淋巴细胞白血病接受长期化疗的儿童进行了睾丸楔形活检。3名儿童（6.5%）发现有隐匿性睾丸浸润。3名经活检证实有浸润的儿童中，2名尽管接受了局部放疗和再诱导化疗，仍死于全身性疾病。43名睾丸活检显示为阴性的儿童中，6名在11个月至15年后复发，6名患者中有3名死于全身性疾病，但无一例发生睾丸疾病。46名儿童中有30名观察到化疗引起的性腺损伤，治疗停止4年后偶尔仍可见肾小管损伤。尽管性腺损伤通常取决于环磷酰胺的累积剂量，但在几名间歇性接受更大剂量环磷酰胺的儿童中发现了完整的肾小管生育指数。急性淋巴细胞白血病的诱导和维持化疗对激素功能影响不大。化疗停止时进行睾丸活检似乎对后续治疗策略有价值，并且需要对长期存活者的性腺损伤进行长期监测。
