Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Surgical Oncology Program of the Children's Hospital Colorado, Aurora, Colorado, USA.
Int J Cancer. 2022 Sep 15;151(6):843-858. doi: 10.1002/ijc.34006. Epub 2022 May 11.
The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.
儿童肾母细胞瘤的存活率目前约为 90%，许多幸存者已进入生育年龄。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。化疗和放疗是性腺损伤的既定危险因素，在 COG 和 SIOP 肾母细胞瘤治疗方案中都有使用。在 Wilms 肿瘤患者中，不孕的风险较低，但随着治疗的强化，包括使用烷化剂、全腹放疗或盆腔放疗，风险会增加。COG 和 SIOP 方案都旨在限制性腺毒性治疗的使用，但不幸的是，并非所有患者都能避免这种治疗。不孕被患者及其家属认为是儿童癌症治疗的最重要的晚期影响之一。因此，及时讨论性腺损伤风险和生育力保存方案很重要。此外，无论选择哪种保存方案，与生育力保存（FP）团队的咨询都与降低患者和家属的遗憾和提高生活质量有关。目前的指南建议早期讨论治疗对潜在生育能力的影响。由于大多数 Wilms 肿瘤患者处于青春期前，因此该群体的潜在 FP 方法仍被认为是实验性的。青春期前男性的 FP 方法尚无确切方法（冷冻保存的睾丸活检为实验性），而青春期前女性只有一种选择（卵巢组织冷冻保存），这既存在技术挑战，也存在伦理挑战。鉴定对性腺毒性治疗敏感的遗传标志物可能有助于对患者的性腺损伤风险进行分层，并确定最有可能从 FP 方法中受益的患者。
