Impact of Oncostatic Treatments for Childhood Malignancies (Radiotherapy and Chemotherapy) on Uterine Competence to Pregnancy

Radiation therapy-associated toxicity: Etiology, management, and prevention

Radiation therapy (RT) is a curative treatment for many malignancies and provides effective palliation in patients with tumor-related symptoms. However, the biophysical effects of RT are not specific to tumor cells and may produce toxicity due to exposure of surrounding organs and tissues. In this article, the authors review the clinical context, pathophysiology, risk factors, presentation, and management of RT side effects in each human organ system. Ionizing radiation works by producing DNA damage leading to tumor death, but effects on normal tissue may result in acute and/or late toxicity. The manifestation of toxicity depends on both cellular characteristics and affected organs' anatomy and physiology. There is usually a direct relationship between the radiation dose and volume to normal tissues and the risk of toxicity, which has led to guidelines and recommended dose limits for most tissues. Side effects are multifactorial, with contributions from baseline patient characteristics and other oncologic treatments. Technological advances in recent decades have decreased RT toxicity by dramatically improving the ability to deliver RT that maximizes tumor dose and minimizes organ dose. Thus the study of RT-associated toxicity is a complex, core component of radiation oncology training that continues to evolve alongside advances in cancer management. Because RT is used in up to one-half of all patients with cancer, an understanding of its acute and late effects in different organ systems is clinically pertinent to both oncologists and nononcologists.

Live birth after embryo transfer in an unresponsive thin endometrium

A healthy term livebirth in a 35-year-old woman with ovarian failure, hypoplastic uterus and atrophic endometrium after cancer treatment with chemotherapy and radiotherapy was achieved by ovum donation. The detection of a receptive endometrium using a new diagnostic tool of endometrial receptivity encouraged the medical team to carry on with this poor prognosis case. To the best of our knowledge, here we report the thinnest endometrium to date in which a healthy, full term live birth has been described in assisted conception.

Assisted reproduction and fertility preservation techniques in cancer patients

PURPOSE OF REVIEW

This study aims to review the current state of different fertility preservation options in patients facing the risk of gonadal failure.

RECENT FINDINGS

Various malignant and nonmalignant diseases have been successfully treated with high-dose chemotherapy or radiotherapy. Even though many young patients receiving these treatments are at risk of developing reproductive failure, a number of fertility preservation options ranging from embryo cryopreservation to ovarian tissue cryopreservation are now available.

SUMMARY

Embryo cryopreservation is a well established technique to preserve fertility. The success rate with oocyte cryopreservation has been on the rise. Both oocyte and embryo freezing require ovarian stimulation and novel ovarian stimulation regimens utilizing aromatase inhibitors which have been developed for ovarian stimulation in women with estrogen sensitive cancer. Even though ovarian tissue cryopreservation is a novel technology, it is the only fertility preservation option for children and the only treatment strategy that can restore ovarian function. In-vitro maturation is a promising technology and can be applied in combination with ovarian tissue cryopreservation.