Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland.
Department of Medical Oncology, Inselspital Bern, University of Bern, Bern, Switzerland.
J Adolesc Young Adult Oncol. 2024 Aug;13(4):597-606. doi: 10.1089/jayao.2023.0185. Epub 2024 Apr 17.
Data on gonadotoxicity of chemotherapies are essential to better counsel young females and males about the risk of infertility and to better indicate fertility preservation measures before cancer therapies. However, such data have not recently been reviewed for bone cancer. Therefore, a systematic literature search was conducted considering papers published since 2000. This study is part of the FertiTOX project, which aims to improve the lack of data regarding gonadotoxicity of cancer therapies to enable more accurate counseling regarding fertility preservation. Only relapse-free women and men were included. Gonadotoxic therapy-induced suspected infertility was defined as very low anti-mullerian hormone, high gonadotropin concentration, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia. The quality of the individual studies was assessed using the Newcastle-Ottawa Scale (NOS). In total, 11 out of 831 studies were included in the review. Suspected infertility was found in 10/190 (5.1%, range 0%-66%) of female patients with osteosarcoma (six studies), in 24/46 (52.2%, range 46%-100%) of male patients with osteosarcoma (three studies), in 18/138 (13.0%, range 3%-18%) of female patients with Ewing's sarcoma (three studies), and in 34/38 (89.5%) of male patients with Ewing's sarcoma (one study). A risk calculation in relation to specific chemotherapies was not possible. Risk of suspected infertility tends to be higher in Ewing's sarcoma in which all patients received chemotherapies with alkylating agents. Two of the 11 included studies received a high NOS quality score, whereas the remaining nine studies received a low quality score, mainly because of the lack of a comparator group. Published data are too limited for precise estimation of the gonadotoxicity. However, data indicate clinically relevant risk for infertility, supporting counseling patients before chemotherapy about fertility preservation measures.
关于化疗引起性腺毒性的数据对于更好地向年轻女性和男性提供关于不孕风险的咨询以及在癌症治疗前更好地指示生育保护措施至关重要。然而，最近并没有针对骨癌进行此类数据的审查。因此，进行了系统的文献搜索，考虑了自 2000 年以来发表的论文。这项研究是 FertiTOX 项目的一部分，该项目旨在改善癌症治疗引起性腺毒性的数据不足，以便更准确地提供有关生育保护的咨询。仅包括无复发生存的女性和男性。性腺毒性治疗引起的疑似不孕定义为非常低的抗苗勒管激素、高促性腺激素浓度、闭经、月经稀少、无精子症或少精子症。使用纽卡斯尔-渥太华量表（NOS）评估个别研究的质量。总共 831 项研究中有 11 项被纳入综述。在骨肉瘤女性患者中，有 10/190（5.1%，范围 0%-66%）发现疑似不孕（六项研究），在骨肉瘤男性患者中，有 24/46（52.2%，范围 46%-100%）发现疑似不孕（三项研究），在尤文氏肉瘤女性患者中，有 18/138（13.0%，范围 3%-18%）发现疑似不孕（三项研究），在尤文氏肉瘤男性患者中，有 34/38（89.5%）发现疑似不孕（一项研究）。与特定化疗药物相关的风险计算是不可能的。在尤文氏肉瘤中，由于所有患者都接受了含烷化剂的化疗，因此疑似不孕的风险似乎更高。这 11 项纳入研究中有两项获得了较高的 NOS 质量评分，而其余九项研究的质量评分较低，主要是因为缺乏对照组。发表的数据对于准确估计性腺毒性还太有限。然而，这些数据表明存在临床相关的不孕风险，支持在化疗前向患者提供生育保护措施的咨询。
