Late reproductive effects of cancer treatment (original) (raw)
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REPRODUCTIVE SEQUELAE OF CANCER TREATMENT
Obstetrics and Gynecology Clinics of North America, 1998
During the past 3 decades, major advances have been made in the cure rates of various malignancies occurring during the reproductive years. Examples of these malignancies include Hodgkin's disease and non-Hodgkin's lymphoma, testicular cancer, germ cell cancers, and acute leukemia. One of the greatest concerns of the younger patient who receives therapy for cancer remains the eventual effect on the reproductive capacity. The temporary and permanent alterations in gonadal function are now recognized as the most prevalent side effects of cancer therapy. This article reviews for the general practitioner the gonadal effects and toxicity of the most common modalities of cancer treatment, including surgery, chemotherapy, and radiotherapy for the malignancies that affect patients of reproductive age. This review should provide the practitioner with scientifically sound information when counseling the patient.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018
Some survivors of childhood, adolescent, and young adult cancer are at increased risk of gonadal dysfunction and adverse pregnancy outcomes. We reviewed currently available literature that evaluated reproductive function and pregnancy outcomes of female cancer survivors diagnosed before the age of 25 years. High-dose alkylating agent chemotherapy and abdominal/pelvic radiotherapy adversely affect gonadal function in a dose-related fashion, with older age at exposure conferring greater risk as a result of the age-related decline in ovarian reserve. Gonadal injury clinically manifests as ovarian hormone insufficiency (delayed or arrested puberty, premature ovarian insufficiency, or premature menopause) and infertility. The effect of molecular-targeted agents on ovarian function has not been established. For female cancer survivors who maintain fertility, overall pregnancy (relative risk, 0.67 to 0.81) and live birth rates (hazard ratio, 0.79 to 0.82) are lower than those in the genera...
Maintaining the reproductive potential of cancer patients during cancer treatment
Frontiers in bioscience, 2014
1. Cancer therapies are known to alter the reproductive potential in cancer patients. Due to improved survival rates in cancer patients of reproductive age, considerations of the long-term effects of cancer therapy have become more significant. Oncofertility is a new discipline in medicine that deals with maintaining the reproductive potential of cancer patients while they are receiving gonadotoxic cancer treatment. The purpose of this review is to explore how cancer treatment impairs reproductive functioning and present the current options for preservation of fertility in women. All patients with reproductive potential should be made aware of the possible treatmentrelated infertility and be offered appropriate fertility preservation options before cancer treatment is instituted. The hope is that, in the future, mechanism(s) can be developed to preserve immature germ cells in the ovary, so that they can be used for fertilization in vivo or in vitro.
Fertility issues for cancer patients
Molecular and Cellular Endocrinology, 2000
The ethos of cancer treatment now lies in 'quality survival'. Fertility potential and preservation for male and female cancer patients has become an important feature of their management. We explore some issues about cancer, its treatment and how it could manifest itself in the fertility and reproductive health of these patients.
Gonadal damage and options for fertility preservation in female and male cancer survivors
Asian Journal of Andrology, 2006
It is estimated that in 2010, 1 in every 250 adults will be a childhood cancer survivor. Today, oncological surgery, radiotherapy and chemotherapy achieve relatively high rates of remission and long-term survival, yet are often detrimental to fertility. Quality of life is increasingly important to long-term survivors of cancer, and one of the major quality-of-life issues is the ability to produce and raise normal children. Developments in the near future in the emerging field of fertility preservation in cancer survivors promise to be very exciting. This article reviews the published literature, discusses the effects of cancer treatment on fertility and presents the options available today thanks to advances in assisted-reproduction technology for maintaining fertility in male and female patients undergoing this type of treatment. The various diagnostic methods of assessing the fertility potential and the efficacy of in vitro fertilization (IVF) after cancer treatment are also presented.
Managing Reproductive Disorders in Cancer.
Cancer affects more than 14 million individuals annually worldwide , of whom 10% are of reproductive age. 1 Among children and adolescents, cancer survival rates range from 71% to 86%, mostly due to successful early detection and effective cancer therapies. However, up to 80% of children, adolescents, and adults with cancer receive treatment that may temporarily or permanently affect their reproductive health, including fertility, gonadal function, and psychosexual well-being. 2 At the heart of the field of oncofer-tility is the consideration of a patient's reproductive health at the same time that decisions are being made about life-preserving but fertility-threatening cancer therapy. Thus, a comprehensive discussion of the endocrine consequences of cancer treatment, including fertility loss, dysfunction of steroid hormone-dependent tissues (e.g., bone and heart), and impaired psychosexual health, as well as a discussion of fertility preservation and contraception options, is critical for optimizing the future quality of life (QoL) of cancer survivors. 3 Current oncology clinical practice guidelines recommend that health care providers engage in an active discussion about the potential effects of cancer therapy on future reproductive health prior to, during, and after treatment. 4 Although there is growing awareness of the impact of cancer treatment on reproductive health among health care providers, up to 50% of patients with cancer are not offered counseling on reproductive health prior to starting cancer treatment. 2,5,6 Cancer patients are deeply s0010 s0015 p0695 p0700 Summary and Next Steps K E Y P O I N T S • With increasing cancer survival the adverse sequelae of the tumor, and treatment thereof, on multiple organ systems have increasingly been recognized. The endocrine system is one of the most frequent organ systems to be affected, with greater than 40% of childhood cancer survivors showing abnormalities. • Oncofertility is a relatively new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. • Aggressive gonadotoxic anticancer regimens including alkylat-ing chemotherapy and total-body irradiation are used often in treating young cancer patients. The risks of gonadotoxicity and subsequent iatrogenic fertility loss depend mainly on the type and stage of the disease, dose and dosage of anticancer therapy, and the age of the patient at the beginning of treatment. • If the risk of gonadotoxicity and subsequent iatrogenic fertility loss is greater than 50% and the patient desires to have children in the future, a fertility preservation and restoration strategy should be initiated before, during, and after chemotherapy and radiotherapy. • Fertility preservation and restoration strategy should be individualized and tailored to the patient's circumstances after obtaining patient informed consent or that of the legal guardians for children. • Fertility preservation and restoration options include gamete and gonadal tissue freezing and further autotransplantation, gonadal protection, gonadal tissue bioengineering, stem cells reproductive technology, and neoadjuvant cytoprotective phar-macotherapy. • A multidisciplinary oncofertility approach involving strong coordination among oncologists, gynecologists, endocrinolo-gists, surgeons, reproductive biologists, research scientists, and patient navigators is essential to ensure a high standard of care. u0655 u0660 u0665 u0670 u0675 u0680 u0685
Life
Fertility counseling should be offered to all individuals of young reproductive age early in the patient’s trajectory following a cancer diagnosis. Systemic cancer treatment and radiotherapy often have an inherent gonadotoxic effect with the potential to induce permanent infertility and premature ovarian failure. For the best chances to preserve a patient’s fertility potential and to improve future quality of life, fertility preservation methods should be applied before cancer treatment initiation, thus multidisciplinary team-work and timely referral to reproductive medicine centers specialized in fertility preservation is recommended. We aim to review the current clinical possibilities for fertility preservation and summarize how infertility, as a late effect of gonadotoxic treatment, affects the growing population of young female cancer survivors.
Reproduction post-chemotherapy in young cancer patients
Molecular and Cellular Endocrinology, 2000
High-dose chemotherapy and radiotherapy has increased long-term survival of young patients with cancer. Sometimes however, the price paid is ovarian failure and sterility. It is highly important to detect who are the patients at risk in order to verify when fertility preservation is indicated. With conventional chemotherapy, there is significant differences in ovarian failure rate according to patients age, disease for which patients are treated for, and the drugs used. Bone marrow transplantation in cancer patients almost invariably induced ovarian failure, irrespective of patient age, treatment protocol or administration of hormonal treatment. Moreover, normal reproductive parameters post-chemotherapy does not necessarily imply that the ovaries escaped damage; ovarian injury is not an all or none phenomenon-partial loss of primordial follicle reserve can result in premature menopause as a delayed reaction to treatment. This should be taken into account while consulting former cancer patients about future planed pregnancies. The direct mechanisms of chemotherapy induced ovarian failure are poorly understood. An in vitro study has demonstrated that in the human ovary chemotherapy acts primarily on primordial follicles through induction of apoptotic changes in pregranulosa cells which lead to follicle loss. Protecting fertility potential in females exposed to chemotherapy with IVF and embryo cryopreservation or cryopreservation of ovarian tissue is practiced. Ovarian tissue cryopreservation: A recent study has demonstrated that laparoscopic ovarian biopsy performed with the round biopter is a safe and efficient method for collecting ovarian tissue for cryopreservation in cancer patients. In order to avoid possible hazards of transferring malignant cells, genetic and immunohistochemical markers for detection of minimal residual cancer cells in ovarian tissue are currently used. However, the reproductive potential of this method is still questionable. IVF: IVF and embryocryopreservation is currently used in infertile patients, however, several obstacles prevent it's wide implementation in cancer patients such as the need for male partner and the time needed for ovarian stimulation. A highly important issue is the possible risk of performing IVF and embryo cryopreservation to preserve fertility in females already exposed to chemotherapy. An animal study has raised serious concerns regarding the consequences of chemotherapy on future pregnancies. High abortion and malformation rates related to the different stages of oocyte maturation at the time of exposure to chemotherapy were demonstrated. These results should be taken into account when considering the use of IVF and embryo cryopreservation following chemotherapy treatment in cancer patients.
The effect of cancer treatment on female fertility and strategies for preserving fertility
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2007
Aggressive chemotherapy and radiotherapy in young patients with cancer has greatly enhanced the life expectancy of these patients, but these treatments often cause infertility because of the massive destruction of the ovarian reserve resulting in premature ovarian failure (POF). This review focuses on the effect of cancer treatments on fertility and on the various surgical and assisted-reproduction innovations that are available to provide the patient with the option of future pregnancies. As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better interdisciplinary cooperation between gynecological and pediatric oncologists, surgeons, immunologists and endocrinologists is necessary so that individualized options for fertility preservation can be offered in advance of surgical procedures or cancer treatments. GnRH analog treatment can preserve fertility in some patients, but not in all. At present, cryopreservation of ovarian tissue appears as a very promising method of providing the cancer patient with a realistic chance of preserving fertility-a prospect that is also extremely important to patients for psychological reasons.